Provider Demographics
NPI:1629634415
Name:CMV IN-HOME ASSISTANCE, INC.
Entity Type:Organization
Organization Name:CMV IN-HOME ASSISTANCE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BILL
Authorized Official - Middle Name:
Authorized Official - Last Name:VANDERPOOL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-333-3268
Mailing Address - Street 1:825 W 3RD ST STE B
Mailing Address - Street 2:
Mailing Address - City:CARUTHERSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63830-1236
Mailing Address - Country:US
Mailing Address - Phone:573-333-3268
Mailing Address - Fax:573-333-5368
Practice Address - Street 1:825 W 3RD ST STE B
Practice Address - Street 2:
Practice Address - City:CARUTHERSVILLE
Practice Address - State:MO
Practice Address - Zip Code:63830-1236
Practice Address - Country:US
Practice Address - Phone:573-333-3268
Practice Address - Fax:573-333-5368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-16
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO253Z00000XMedicaid
MO3747P1801XMedicaid
MO372500000XMedicaid