Provider Demographics
NPI:1265684922
Name:BENCHMARK HEALTHCARE
Entity Type:Organization
Organization Name:BENCHMARK HEALTHCARE
Other - Org Name:RAMSEY CREEK VILLAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DERENDA
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:TIPPY
Authorized Official - Suffix:
Authorized Official - Credentials:LPN/ADM
Authorized Official - Phone:573-264-1555
Mailing Address - Street 1:28601 US HIGHWAY 61
Mailing Address - Street 2:
Mailing Address - City:SCOTT CITY
Mailing Address - State:MO
Mailing Address - Zip Code:63780-9143
Mailing Address - Country:US
Mailing Address - Phone:573-264-1555
Mailing Address - Fax:573-264-1556
Practice Address - Street 1:28601 US HIGHWAY 61
Practice Address - Street 2:
Practice Address - City:SCOTT CITY
Practice Address - State:MO
Practice Address - Zip Code:63780-9143
Practice Address - Country:US
Practice Address - Phone:573-264-1555
Practice Address - Fax:573-264-1556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-14
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO029719310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility