Provider Demographics
NPI:1609994078
Name:BAILEY STREET RESIDENTIAL CARE 1
Entity Type:Organization
Organization Name:BAILEY STREET RESIDENTIAL CARE 1
Other - Org Name:DEBORAH K FRANKS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:FRANKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-756-6374
Mailing Address - Street 1:102 BAILEY ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63640-1819
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:102 BAILEY ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MO
Practice Address - Zip Code:63640-1819
Practice Address - Country:US
Practice Address - Phone:573-756-6374
Practice Address - Fax:573-756-1823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO033211251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO26688200Medicaid