Provider Demographics
NPI:1093903981
Name:HARTEGAN,INC
Entity Type:Organization
Organization Name:HARTEGAN,INC
Other - Org Name:LONGBLUM RETIREMENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:HARTEGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-682-5744
Mailing Address - Street 1:11301 E GREENFIELD RD
Mailing Address - Street 2:
Mailing Address - City:CENTRALIA
Mailing Address - State:MO
Mailing Address - Zip Code:65240-3530
Mailing Address - Country:US
Mailing Address - Phone:573-682-5744
Mailing Address - Fax:573-682-3493
Practice Address - Street 1:1301 MONROE ST
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:MO
Practice Address - Zip Code:64601-1345
Practice Address - Country:US
Practice Address - Phone:660-646-5180
Practice Address - Fax:660-646-5181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-04
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO034513320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities