Provider Demographics
NPI:1447396965
Name:RATLIFF ENTERPRISES LLC
Entity Type:Organization
Organization Name:RATLIFF ENTERPRISES LLC
Other - Org Name:SPRIGG STREET MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:RATLIFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-335-5810
Mailing Address - Street 1:701 N SPRIGG
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63701-4815
Mailing Address - Country:US
Mailing Address - Phone:573-334-2975
Mailing Address - Fax:573-651-8998
Practice Address - Street 1:701 N SPRIGG
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701-4815
Practice Address - Country:US
Practice Address - Phone:573-334-2975
Practice Address - Fax:573-651-8998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO032399310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
265747Medicare ID - Type Unspecified