Provider Demographics
NPI:1760687529
Name:ESSEX RESIDENTIAL CARE
Entity Type:Organization
Organization Name:ESSEX RESIDENTIAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:ALTON
Authorized Official - Last Name:ELLIOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-471-5503
Mailing Address - Street 1:24898 STATE HIGHWAY AB
Mailing Address - Street 2:
Mailing Address - City:ESSEX
Mailing Address - State:MO
Mailing Address - Zip Code:63846-8167
Mailing Address - Country:US
Mailing Address - Phone:573-568-5622
Mailing Address - Fax:
Practice Address - Street 1:24898 STATE HIGHWAY AB
Practice Address - Street 2:
Practice Address - City:ESSEX
Practice Address - State:MO
Practice Address - Zip Code:63846-8167
Practice Address - Country:US
Practice Address - Phone:573-568-5622
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-20
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility