Provider Demographics
NPI:1508504853
Name:CROSSTREE HEALTHCARE MINGO LLC
Entity Type:Organization
Organization Name:CROSSTREE HEALTHCARE MINGO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-217-8669
Mailing Address - Street 1:2061 MAGNOLIA DR
Mailing Address - Street 2:
Mailing Address - City:PIGGOTT
Mailing Address - State:AR
Mailing Address - Zip Code:72454-3129
Mailing Address - Country:US
Mailing Address - Phone:573-217-8669
Mailing Address - Fax:
Practice Address - Street 1:24080 STATE HIGHWAY 51
Practice Address - Street 2:
Practice Address - City:PUXICO
Practice Address - State:MO
Practice Address - Zip Code:63960-8114
Practice Address - Country:US
Practice Address - Phone:573-217-8669
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-26
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility