| NPI | 1114272374 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL LEON SULLIVAN PT A 417-840-1588 |
| Organization Subpart ? | No |
| Primary Taxonomy | 314000000X Skilled Nursing Facility (Licence: MO 116911) |
| Additional Taxonomies | 313M00000X Nursing Facility/Intermediate Care Facility (Licence: MO 116911) |
| Enumeration Date | 2012-07-13 |
| Last Update Date | 2012-07-13 |