Provider Demographics
NPI:1518177591
Name:MISSOURI VETERANS COMMISSION
Entity Type:Organization
Organization Name:MISSOURI VETERANS COMMISSION
Other - Org Name:MISSOURI VETERANS HOME - CO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:HAL
Authorized Official - Middle Name:
Authorized Official - Last Name:DULLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-751-3779
Mailing Address - Street 1:PO BOX 147
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65102-0147
Mailing Address - Country:US
Mailing Address - Phone:573-751-3779
Mailing Address - Fax:573-751-6836
Practice Address - Street 1:205 JEFFERSON ST FL 12
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65101-2901
Practice Address - Country:US
Practice Address - Phone:573-751-3779
Practice Address - Fax:573-751-6836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility