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Contact Information

ELDERCARE OF MID-MISSOURI IV, INC.
1550 VILLA DR
DE SOTO, MO63020-2586
 Phone: 636-586-6559
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Skilled Nursing Facility

314000000X A1[8] Skilled Nursing Facility
 

Nursing Care

251J00000X
Indicates primary specialty

NPI Profile & details for ELDERCARE OF MID-MISSOURI IV, INC.

NPI Number 1487811436
LBN Legal business name ELDERCARE OF MID-MISSOURI IV, INC.
Authorized official MARK LIERMAN - (SECRETARY - TREASURER)
Entity Organization
Organization subpart 1 No
Enumeration date 05/19/2008
Last updated 12/01/2020 - About 6 years ago
Identifiers
MO License # 035678
MO Medicaid 107812307
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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