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General NPI Number Information
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NPI Number | 1760687529
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Entity Type | Organization
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Legal Business Name | ESSEX RESIDENTIAL CARE
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Dates
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Enumeration Date | 06/20/2007
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Last Update Date | 07/24/2007
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Provider Practice Location Address
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Address Line | 24898 STATE HIGHWAY AB
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City | ESSEX
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State | MO
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Zip | 63846-8167
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Country | US
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Telephone | 573-568-5622
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Fax |
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Provider Business Mailing Address
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Address Line | 24898 STATE HIGHWAY AB
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City | ESSEX
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State | MO
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Zip | 63846-8167
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Country | US
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Telephone | 573-568-5622
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | THEODORE ALTON ELLIOTT
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Credential |
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Telephone | 573-471-5503
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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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