Provider Demographics
NPI:1407990260
Name:MARY V. HUTCHISON
Entity Type:Organization
Organization Name:MARY V. HUTCHISON
Other - Org Name:COUNTRY VALLEY HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:V
Authorized Official - Last Name:HUTCHISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-265-8250
Mailing Address - Street 1:15750 COUNTY ROAD 2430
Mailing Address - Street 2:
Mailing Address - City:SAINT JAMES
Mailing Address - State:MO
Mailing Address - Zip Code:65559-8211
Mailing Address - Country:US
Mailing Address - Phone:573-265-8250
Mailing Address - Fax:573-265-8250
Practice Address - Street 1:15750 COUNTY ROAD 2430
Practice Address - Street 2:
Practice Address - City:SAINT JAMES
Practice Address - State:MO
Practice Address - Zip Code:65559-8211
Practice Address - Country:US
Practice Address - Phone:573-265-8250
Practice Address - Fax:573-265-8250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0322483104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO266794007Medicaid