INDEPENDENCE HEALTH SYSTEM, INC.
Assisted Living Facility
Perryville, Missouri
Provider NPI: 1619963972
Organization Information:Organization Name: INDEPENDENCE HEALTH SYSTEM, INC.
Practice Location:
800 S KINGSHIGHWAY ST PERRYVILLE, MO 63775 US
Tel: 573-547-6546 Fax: --
Business Mailing Address:
,
Tel: -- Fax: --
Taxonomy:
Other Provider Identifiers:
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin
Practice Location:
800 S KINGSHIGHWAY ST PERRYVILLE, MO 63775 US
Tel: 573-547-6546 Fax: --
Business Mailing Address:
,
Tel: -- Fax: --
Taxonomy:
Primary | Code | Category/Description | State | License Number |
---|---|---|---|---|
N | 310400000X | Nursing & Custodial Care Facilities Assisted Living Facility | MO | 031348 |
Y | 314000000X | Nursing & Custodial Care Facilities Skilled Nursing Facility | MO | 031654 |
Other Provider Identifiers:
Issuer | Number | State | Type |
---|---|---|---|
101493203 | MO | 05 | |
268114808 | MO | 05 |
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin