=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740347780
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RICKMAN ENTERPRISES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/02/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 227 W FRANKLIN ST
-----------------------------------------------------
City | LIBERTY
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64068-1641
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-781-8058
-----------------------------------------------------
Fax | 816-781-8058
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 227 W FRANKLIN ST
-----------------------------------------------------
City | LIBERTY
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64068-1641
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-781-8058
-----------------------------------------------------
Fax | 816-781-8058
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MS. SUE ANN RICKMAN CANSLER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 816-781-8058
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number | 033353
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------