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NPI Code Detail

MEDICARE: ELDERCARE OF MID-MISSOURI IX, INC.

MEDICARE: ELDERCARE OF MID-MISSOURI IX, 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
1314000000XSkilled Nursing Facility

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1154588085
Entity Type Code : Organization
Provider Name (Legal Business Name) : ELDERCARE OF MID-MISSOURI IX, INC.
Provider Business Mailing Address
First Line : 2601 FAIR ST
Second Line :
City : CHILLICOTHEE
State : MO
Zip : 64601-3525
Country : US
Telephone Number : 636-477-3280
Fax Number :
Provider Business Practice Location Address
First Line : 2601 FAIR ST
Second Line :
City : CHILLICOTHEE
State : MO
Zip : 64601-3525
Country : US
Telephone Number : 660-646-1230
Fax Number :
Authorized Official
Title or Position : AUTHORIZED OFFICIAL
Name : MARK LIERMAN
Credential :
Telephone Number : 636-477-3280
Provider Enumeration Date : 05/19/2008
Last Update Date : 12/01/2020

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