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General NPI Number Information
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NPI Number | 1740143064
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Entity Type | Organization
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Legal Business Name | LIFE ENHANCEMENT VILLAGE OPERATING COMPANY LLC
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Dates
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Enumeration Date | 12/04/2025
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Last Update Date | 12/04/2025
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Provider Practice Location Address
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Address Line | 732 S GREGG RD
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City | NIXA
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State | MO
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Zip | 65714-7419
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Country | US
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Telephone | 417-725-6680
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Fax |
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Provider Business Mailing Address
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Address Line | 2732 N OAK PARK DR
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City | SPRINGFIELD
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State | MO
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Zip | 65803-2084
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Country | US
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Telephone | 417-763-0704
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOSEPHAT K BITOK
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Credential |
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Telephone | 417-763-0704
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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License Number |
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License Number State |
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