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General NPI Number Information
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NPI Number | 1801284641
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Entity Type | Organization
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Legal Business Name | MOM AND POP'S ADULT CARE CENTER
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Dates
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Enumeration Date | 01/02/2015
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Last Update Date | 01/02/2015
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Provider Practice Location Address
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Address Line | 905 N PRICE LN
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City | CLINTON
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State | MO
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Zip | 64735-1721
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Country | US
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Telephone | 660-885-1095
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Fax |
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Provider Business Mailing Address
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Address Line | 905 N PRICE LN
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City | CLINTON
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State | MO
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Zip | 64735-1721
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Country | US
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Telephone | 660-885-1095
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Fax |
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Authorized Official
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Title or Position | OWNER/DIRECTOR
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Name | MS. LISA RENEE BAIN
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Credential | LPN
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Telephone | 660-200-6891
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | 1220
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License Number State | MO
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