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General NPI Number Information
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NPI Number | 1801004577
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Entity Type | Organization
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Legal Business Name | ENOCHS CARE CENTER
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Dates
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Enumeration Date | 05/18/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 207 W SUMMER ST
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City | MONROE CITY
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State | MO
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Zip | 63456-1535
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Country | US
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Telephone | 573-735-2534
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Fax |
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Provider Business Mailing Address
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Address Line | 207 W SUMMER ST
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City | MONROE CITY
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State | MO
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Zip | 63456-1535
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Country | US
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Telephone | 573-735-2534
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. PATRICIA ELLEN ENOCHS
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Credential |
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Telephone | 573-735-2534
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number | 8001366
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License Number State | MO
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