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General NPI Number Information
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NPI Number | 1992790398
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Entity Type | Organization
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Legal Business Name | CLARK COUNTY NURSING SERVICE & HOME HEALTH AGENCY
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Dates
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Enumeration Date | 09/13/2005
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Last Update Date | 03/26/2013
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Provider Practice Location Address
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Address Line | 670 N JOHNSON ST
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City | KAHOKA
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State | MO
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Zip | 63445-1430
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Country | US
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Telephone | 660-727-2356
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Fax | 660-727-2927
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Provider Business Mailing Address
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Address Line | 670 N JOHNSON ST P O BOX 12
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City | KAHOKA
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State | MO
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Zip | 63445-1430
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Country | US
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Telephone | 660-727-2356
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Fax | 660-727-2927
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | M. EVELENA SUTTERFIELD
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Credential | RN
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Telephone | 660-727-2356
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number |
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License Number State |
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