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COUNTRY CLUB CARE CENTER OF WARRENSBURG L C NPI 1356481907


NPI Information

NPI: 1356481907
Provider Name: COUNTRY CLUB CARE CENTER OF WARRENSBURG L C

Doing Business As: COUNTRY CLUB CARE CENTER

Classification: Residential Treatment Facility, Physical Disabilities - 320700000X
Entity Type: Organization
Address:
503 REGENT DR
WARRENSBURG, MO
ZIP 64093
Phone: (660) 429-4444
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COUNTRY CLUB CARE CENTER OF WARRENSBURG L C is a residential treatment facility physical disabilities in Warrensburg, MO. The provider is a residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with physical disabilities and are not able to live independently. COUNTRY CLUB CARE CENTER OF WARRENSBURG L C NPI is 1356481907. The provider is registered as an organization entity type.
The provider Is Doing Business As Country Club Care Center.

The provider's business location address is:

503 REGENT DR
WARRENSBURG, MO
ZIP 64093-231
Phone: (660) 429-4444
Fax: (660) 429-4331

The provider's authorized official is Steve Bunch .
The authorized official title is Vice President Of Operations and has the following contact phone number (660) 429-4444.

The enumeration date for this NPI number is 2/6/2007 and was last updated on 6/17/2008.


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 CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1320700000XResidential Treatment Facility, Physical Disabilities035594MISSOURIYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1268298007MEDICAIDMISSOURI

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: 11/14/2023

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