Provider Demographics
NPI:1215209226
Name:BSLC II
Entity Type:Organization
Organization Name:BSLC II
Other - Org Name:THE GARDENS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF ACCOUNTING
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-481-0100
Mailing Address - Street 1:1302 WEST SUNSET
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-5943
Mailing Address - Country:US
Mailing Address - Phone:417-889-7600
Mailing Address - Fax:417-889-2477
Practice Address - Street 1:1302 WEST SUNSET
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-5943
Practice Address - Country:US
Practice Address - Phone:417-889-7600
Practice Address - Fax:417-889-2477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-07
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO039726310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility