Provider Demographics
NPI:1629283379
Name:YOUR FAMILY CARE CLINIC RURAL HEALTH CLINIC LLC
Entity Type:Organization
Organization Name:YOUR FAMILY CARE CLINIC RURAL HEALTH CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:CROSSKNO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-575-4416
Mailing Address - Street 1:207 BESSIE STREET
Mailing Address - Street 2:
Mailing Address - City:HORNERSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63855-0009
Mailing Address - Country:US
Mailing Address - Phone:573-575-4416
Mailing Address - Fax:573-695-2012
Practice Address - Street 1:207 BESSIE STREET
Practice Address - Street 2:
Practice Address - City:HORNERSVILLE
Practice Address - State:MO
Practice Address - Zip Code:63855-0009
Practice Address - Country:US
Practice Address - Phone:573-575-4416
Practice Address - Fax:573-695-2012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health