CROSSTREE HEALTHCARE LLC NPI 1063188035

NPI Information

  • NPI: 1063188035
  • Provider Name: CROSSTREE HEALTHCARE LLC
  • Classification: Assisted Living Facility - 310400000X
  • Entity Type: Organization
  • Doing Business As: SOUTHAVEN
  • CLIA Number: 26D2117763
  • Address: 612 SOUTH BYP
    KENNETT, MO
    ZIP 63857
  • Phone: (573) 217-8669

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NPI Details

CROSSTREE HEALTHCARE LLC is an assisted living facility in Kennett, MO. The provider is a facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. CROSSTREE HEALTHCARE LLC NPI is 1063188035. The provider is registered as an organization entity type.
The provider Is Doing Business As Southaven.

The provider's business location address is:

612 SOUTH BYP
KENNETT, MO
ZIP 63857-240
Phone: (573) 217-8669

The provider's authorized official is Scott Cole .
The authorized official title is Owner and has the following contact phone number (573) 217-8669.

The CLIA number assigned to this NPI record is 26D2117763 - assisted living facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 8/19/2021 and was last updated on 10/25/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1310400000XAssisted Living FacilityYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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