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General NPI Number Information
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NPI Number | 1710146832
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Entity Type | Organization
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Legal Business Name | RIVERWAYS SUPPORT SERVICES
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Dates
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Enumeration Date | 06/04/2008
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Last Update Date | 06/04/2008
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Provider Practice Location Address
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Address Line | 114 E MAIN ST
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City | WEST PLAINS
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State | MO
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Zip | 65775-3556
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Country | US
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Telephone | 417-256-0191
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Fax |
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Provider Business Mailing Address
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Address Line | 114 E MAIN ST
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City | WEST PLAINS
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State | MO
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Zip | 65775-3556
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Country | US
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Telephone | 417-256-0191
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Fax |
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Authorized Official
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Title or Position | LEAD OFFICE ASSISTANT
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Name | CARRIE LYN WOMACK
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Credential |
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Telephone | 417-256-0191
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | 940563208
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License Number State | MO
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