Provider Demographics
NPI:1033116819
Name:HEALTH SERVICES OF DEXTER, INC
Entity Type:Organization
Organization Name:HEALTH SERVICES OF DEXTER, INC
Other - Org Name:CYPRESS POINT SKILLED NURSING CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:VICE PRESIDENT - FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:REIKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-471-1113
Mailing Address - Street 1:801 BAILIFF DR
Mailing Address - Street 2:
Mailing Address - City:DEXTER
Mailing Address - State:MO
Mailing Address - Zip Code:63841-9500
Mailing Address - Country:US
Mailing Address - Phone:573-624-8908
Mailing Address - Fax:573-624-5193
Practice Address - Street 1:801 BAILIFF DR
Practice Address - Street 2:
Practice Address - City:DEXTER
Practice Address - State:MO
Practice Address - Zip Code:63841-9500
Practice Address - Country:US
Practice Address - Phone:573-624-8908
Practice Address - Fax:573-624-5193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO029587314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO265367Medicare ID - Type Unspecified