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General NPI Number Information
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NPI Number | 1598860074
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Entity Type | Organization
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Legal Business Name | LABELLE MANOR INC
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Dates
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Enumeration Date | 09/13/2006
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Last Update Date | 05/14/2009
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Provider Practice Location Address
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Address Line | 1002 CENTRAL ST
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City | LA BELLE
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State | MO
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Zip | 63447-2092
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Country | US
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Telephone | 660-213-3234
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Fax | 660-213-3845
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Provider Business Mailing Address
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Address Line | 1002 CENTRAL ST
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City | LA BELLE
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State | MO
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Zip | 63447-2092
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Country | US
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Telephone | 660-213-3234
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Fax | 660-213-3845
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. IZENA MONK
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Credential | LNHA
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Telephone | 660-213-3234
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 027017
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License Number State | MO
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