MEDICARE: CAMBRIDGE OF BRANSON LLC

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	261QA0600X	Adult Day Care Clinic/Center	1291	MO
2	261QA0600X	Adult Day Care Clinic/Center

Other Identifiers

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

General Provider Information

NPI Number	:	1760855431
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAMBRIDGE OF BRANSON LLC

Provider Business Mailing Address
First Line	:	4675 N GRETNA RD STE 201
Second Line	:
City	:	BRANSON
State	:	MO
Zip	:	65616-7583
Country	:	US
Telephone Number	:	417-339-4232
Fax Number	:	417-334-5087

Provider Business Practice Location Address
First Line	:	4470 N GRETNA RD
Second Line	:
City	:	BRANSON
State	:	MO
Zip	:	65616-7202
Country	:	US
Telephone Number	:	417-544-0630
Fax Number	:	417-544-0671

Authorized Official
Title or Position	:	PROGRAM DIRECTOR
Name	:	MRS. JANICE LYNN GOODMAN
Credential	:
Telephone Number	:	417-544-0630

Provider Enumeration Date	:	11/03/2015
Last Update Date	:	04/15/2021

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