Provider Demographics
NPI:1780632026
Name:ST CLAIR COUNTY HEALTH CENTER
Entity Type:Organization
Organization Name:ST CLAIR COUNTY HEALTH CENTER
Other - Org Name:ST CLAIR COUNTY HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:STEPHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-646-8157
Mailing Address - Street 1:530 ARDUSER DR
Mailing Address - Street 2:
Mailing Address - City:OSCEOLA
Mailing Address - State:MO
Mailing Address - Zip Code:64776-6284
Mailing Address - Country:US
Mailing Address - Phone:417-646-8157
Mailing Address - Fax:417-646-8159
Practice Address - Street 1:530 ARDUSER DR
Practice Address - Street 2:
Practice Address - City:OSCEOLA
Practice Address - State:MO
Practice Address - Zip Code:64776-6284
Practice Address - Country:US
Practice Address - Phone:417-646-8157
Practice Address - Fax:417-646-8159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO96-21251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO581936606Medicaid
MO267147Medicare ID - Type Unspecified