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General NPI Number Information
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NPI Number | 1932758125
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Entity Type | Organization
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Legal Business Name | PROACTIVE HOME CARE MISSOURI
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Dates
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Enumeration Date | 09/10/2019
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Last Update Date | 09/10/2019
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Provider Practice Location Address
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Address Line | 104B W MOUNT VERNON BLVD
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City | MOUNT VERNON
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State | MO
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Zip | 65712-1936
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Country | US
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Telephone | 417-850-2013
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Fax | 417-855-2242
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Provider Business Mailing Address
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Address Line | 104B W MOUNT VERNON BLVD
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City | MOUNT VERNON
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State | MO
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Zip | 65712-1936
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Country | US
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Telephone | 417-850-2013
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Fax | 417-855-2242
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Authorized Official
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Title or Position | MANAGER
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Name | MRS. SADIE K MUSICK
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Credential |
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Telephone | 417-380-3829
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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