Provider Demographics
NPI:1508073040
Name:RETIREMENT AT CENTURY PINES INC.
Entity Type:Organization
Organization Name:RETIREMENT AT CENTURY PINES INC.
Other - Org Name:CENTURY PINES ASSISTED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:L
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-581-7278
Mailing Address - Street 1:709 E. MCCRACKEN
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:MO
Mailing Address - Zip Code:65721
Mailing Address - Country:US
Mailing Address - Phone:417-581-7278
Mailing Address - Fax:417-581-4461
Practice Address - Street 1:709 E. MCCRACKEN
Practice Address - Street 2:
Practice Address - City:OZARK
Practice Address - State:MO
Practice Address - Zip Code:65721
Practice Address - Country:US
Practice Address - Phone:417-581-7278
Practice Address - Fax:417-581-4461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO310400000X
MO034573310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO266757301Medicaid
MO26675730Medicaid