Provider Demographics
NPI:1275537714
Name:SAC OSAGE HOME HEALTH CARE INC
Entity Type:Organization
Organization Name:SAC OSAGE HOME HEALTH CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-876-5225
Mailing Address - Street 1:1780 E HIGHWAY 54
Mailing Address - Street 2:
Mailing Address - City:EL DORADO SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64744-8169
Mailing Address - Country:US
Mailing Address - Phone:417-876-5225
Mailing Address - Fax:417-876-2058
Practice Address - Street 1:1780 E HIGHWAY 54
Practice Address - Street 2:
Practice Address - City:EL DORADO SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64744-8169
Practice Address - Country:US
Practice Address - Phone:417-876-5225
Practice Address - Fax:417-876-2058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-13
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO743-2251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO260563606Medicaid
MO580563609Medicaid
MO280563602Medicaid
MO940563604Medicaid
MO260563606Medicaid