MEDICARE: HEALTH SERVICES OF FARMINGTON, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	030990	MO

General Provider Information

NPI Number	:	1114924800
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTH SERVICES OF FARMINGTON, INC

Provider Business Mailing Address
First Line	:	1108 W LIBERTY ST
Second Line	:
City	:	FARMINGTON
State	:	MO
Zip	:	63640-1922
Country	:	US
Telephone Number	:	573-756-6658
Fax Number	:	573-756-8663

Provider Business Practice Location Address
First Line	:	1108 W LIBERTY ST
Second Line	:
City	:	FARMINGTON
State	:	MO
Zip	:	63640-1922
Country	:	US
Telephone Number	:	573-756-6658
Fax Number	:	573-756-8663

Authorized Official
Title or Position	:	VICE PRESIDENT - FINANCE
Name	:	JAMES REIKER
Credential	:
Telephone Number	:	573-471-1113

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	08/22/2020

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