Provider Demographics
NPI:1629793484
Name:STOVER'S RESIDENTIAL CARE FACILITY
Entity Type:Organization
Organization Name:STOVER'S RESIDENTIAL CARE FACILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAMBERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-640-6433
Mailing Address - Street 1:520 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:MILAN
Mailing Address - State:MO
Mailing Address - Zip Code:63556-1222
Mailing Address - Country:US
Mailing Address - Phone:660-265-3262
Mailing Address - Fax:
Practice Address - Street 1:520 E 5TH ST
Practice Address - Street 2:
Practice Address - City:MILAN
Practice Address - State:MO
Practice Address - Zip Code:63556-1222
Practice Address - Country:US
Practice Address - Phone:660-265-3262
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HORIZONS HEALTH SENIOR CARE GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-10-05
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities