Provider Demographics
NPI:1356450506
Name:PATRICIA'S RESIDENTIAL CARE FACILITY
Entity Type:Organization
Organization Name:PATRICIA'S RESIDENTIAL CARE FACILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHEVIS
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:ALCORN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-598-4202
Mailing Address - Street 1:510 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MO
Mailing Address - Zip Code:63620-9104
Mailing Address - Country:US
Mailing Address - Phone:573-598-4202
Mailing Address - Fax:573-598-3885
Practice Address - Street 1:510 E 2ND ST
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MO
Practice Address - Zip Code:63620-9104
Practice Address - Country:US
Practice Address - Phone:573-598-4202
Practice Address - Fax:573-598-3885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO031336310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility