Provider Demographics
NPI:1285688416
Name:HANK VENTURES INC.
Entity Type:Organization
Organization Name:HANK VENTURES INC.
Other - Org Name:THE LODGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:TONI
Authorized Official - Middle Name:L
Authorized Official - Last Name:HART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-248-2277
Mailing Address - Street 1:542 STATE ROUTE DD
Mailing Address - Street 2:
Mailing Address - City:FAYETTE
Mailing Address - State:MO
Mailing Address - Zip Code:65248-9658
Mailing Address - Country:US
Mailing Address - Phone:660-248-2277
Mailing Address - Fax:660-248-3699
Practice Address - Street 1:542 STATE ROUTE DD
Practice Address - Street 2:
Practice Address - City:FAYETTE
Practice Address - State:MO
Practice Address - Zip Code:65248-9658
Practice Address - Country:US
Practice Address - Phone:660-248-2277
Practice Address - Fax:660-248-3699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO041482310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO266737006Medicaid