Provider Demographics
NPI:1437574183
Name:MISSOURI CARIS HEALTHCARE LLC
Entity Type:Organization
Organization Name:MISSOURI CARIS HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCRAE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-694-4762
Mailing Address - Street 1:13995 CLAYTON ROAD
Mailing Address - Street 2:
Mailing Address - City:TOWN & COUNTRY
Mailing Address - State:MO
Mailing Address - Zip Code:63017
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13995 CLAYTON ROAD
Practice Address - Street 2:
Practice Address - City:TOWN & COUNTRY
Practice Address - State:MO
Practice Address - Zip Code:63017
Practice Address - Country:US
Practice Address - Phone:866-694-4848
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CARIS HEALTHCARE LP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-03-04
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
261655Medicare Oscar/Certification