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General NPI Number Information
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NPI Number | 1700609658
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Entity Type | Organization
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Legal Business Name | WEBWOOD ASSISTED LIVING LLC
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Dates
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Enumeration Date | 11/07/2024
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Last Update Date | 11/07/2024
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Provider Practice Location Address
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Address Line | 1640 WALDO HATLER MEMORIAL DR
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City | NEOSHO
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State | MO
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Zip | 64850-8059
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Country | US
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Telephone | 417-451-2997
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Fax | 417-456-6345
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Provider Business Mailing Address
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Address Line | 3590 OLD HIGHWAY 54
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City | LAKE OZARK
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State | MO
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Zip | 65049-9008
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | ETHAN WILSON
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Credential |
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Telephone | 417-451-2997
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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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