Provider Demographics
NPI:1366658676
Name:BRISTOL CARE, INC.
Entity Type:Organization
Organization Name:BRISTOL CARE, INC.
Other - Org Name:BRISTOL MANOR OF LAMAR
Other - Org Type:Other Name
Authorized Official - Title/Position:MEDICAID BILLING DEPARTMENT
Authorized Official - Prefix:
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:DEANNE
Authorized Official - Last Name:EBELING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-826-0200
Mailing Address - Street 1:201 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:SEDALIA
Mailing Address - State:MO
Mailing Address - Zip Code:65301-4352
Mailing Address - Country:US
Mailing Address - Phone:660-826-0200
Mailing Address - Fax:660-827-2027
Practice Address - Street 1:603 E 17TH ST
Practice Address - Street 2:
Practice Address - City:LAMAR
Practice Address - State:MO
Practice Address - Zip Code:64759-2303
Practice Address - Country:US
Practice Address - Phone:417-682-6762
Practice Address - Fax:417-682-6762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility