Provider Demographics
NPI:1548394166
Name:PEACH WOOD MANOR RCF
Entity Type:Organization
Organization Name:PEACH WOOD MANOR RCF
Other - Org Name:PEACH WOOD MANOR
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LYNDA
Authorized Official - Middle Name:GAIL
Authorized Official - Last Name:DACY
Authorized Official - Suffix:
Authorized Official - Credentials:CMA
Authorized Official - Phone:417-847-3902
Mailing Address - Street 1:HC 81
Mailing Address - Street 2:BOX 8240
Mailing Address - City:CASSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65625
Mailing Address - Country:US
Mailing Address - Phone:417-847-3902
Mailing Address - Fax:417-847-0052
Practice Address - Street 1:HIGHWAY 12
Practice Address - Street 2:
Practice Address - City:CASSVILLE
Practice Address - State:MO
Practice Address - Zip Code:65625
Practice Address - Country:US
Practice Address - Phone:417-847-3902
Practice Address - Fax:417-847-0052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home