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General NPI Number Information
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NPI Number | 1780280958
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Entity Type | Organization
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Legal Business Name | BIG PRAIRIE ASSISTED LIVING, LLC
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Dates
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Enumeration Date | 12/11/2020
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Last Update Date | 12/11/2020
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Provider Practice Location Address
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Address Line | 411 NORTH KINGSHIGHWAY
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City | SIKESTON
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State | MO
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Zip | 63801
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Country | US
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Telephone | 573-471-5505
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 456
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City | PARMA
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State | MO
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Zip | 63870-0456
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Country | US
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Telephone | 573-683-1355
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | BOBBIE DENISE YOUNG
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Credential | RN, BSN
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Telephone | 573-683-1355
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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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