Provider Demographics
NPI:1679641229
Name:HULETT ENTERPRISES DBA STOVERS RESIDENTIAL CARE FACILITY
Entity Type:Organization
Organization Name:HULETT ENTERPRISES DBA STOVERS RESIDENTIAL CARE FACILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:HULETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-265-3262
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:660-857-4413
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:660-857-4413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0334433104A0630X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances