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NPI Code Detail

MEDICARE: BRISTOL CARE, INC.

MEDICARE: BRISTOL CARE, 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
1310400000XAssisted Living Facility

General Provider Information

NPI Number : 1245446293
Entity Type Code : Organization
Provider Name (Legal Business Name) : BRISTOL CARE, INC.
Provider Business Mailing Address
First Line : 201 W 3RD ST
Second Line :
City : SEDALIA
State : MO
Zip : 65301-4352
Country : US
Telephone Number : 660-826-0200
Fax Number : 660-827-2027
Provider Business Practice Location Address
First Line : 603 SAINT LOUIS AVE
Second Line :
City : CHILLICOTHEE
State : MO
Zip : 64601-2438
Country : US
Telephone Number : 660-717-1270
Fax Number : 660-717-1270
Authorized Official
Title or Position : MEDICAID BILLING DEPARTMENT
Name : SHELLEY D EBELING
Credential :
Telephone Number : 660-826-0200
Provider Enumeration Date : 05/15/2007
Last Update Date : 10/02/2007

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Directions to “BRISTOL CARE, INC. ” Practice Location

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