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General NPI Number Information
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NPI Number | 1689621435
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Entity Type | Organization
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Legal Business Name | NEOSHO RESIDENTIAL, LLC
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Dates
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Enumeration Date | 05/27/2006
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Last Update Date | 02/03/2021
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Provider Practice Location Address
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Address Line | 1105 VILLAGE RD
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City | NEOSHO
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State | MO
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Zip | 64850-9076
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Country | US
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Telephone | 417-451-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 1105 VILLAGE RD
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City | NEOSHO
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State | MO
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Zip | 64850-9076
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Country | US
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Telephone | 417-451-1000
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Fax |
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Authorized Official
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Title or Position | TREASURER
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Name | JAMES REIKER
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Credential |
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Telephone | 573-471-1113
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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