Provider Demographics
NPI:1639219967
Name:PHILIP GREG ORDWAY
Entity Type:Organization
Organization Name:PHILIP GREG ORDWAY
Other - Org Name:WW COUNTRY HOME ISL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:ORDWAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-336-8831
Mailing Address - Street 1:106 GALEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BRANSON
Mailing Address - State:MO
Mailing Address - Zip Code:65616-7289
Mailing Address - Country:US
Mailing Address - Phone:417-336-8831
Mailing Address - Fax:
Practice Address - Street 1:105 GALEWOOD DR
Practice Address - Street 2:
Practice Address - City:BRANSON
Practice Address - State:MO
Practice Address - Zip Code:65616-7289
Practice Address - Country:US
Practice Address - Phone:417-336-8831
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO858635006Medicaid