Provider Demographics
NPI:1831495647
Name:BROOK CHERITH ASSISTED LIVING
Entity Type:Organization
Organization Name:BROOK CHERITH ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KALLMEYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-277-4439
Mailing Address - Street 1:104 E ELM ST
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65259-1111
Mailing Address - Country:US
Mailing Address - Phone:660-277-4439
Mailing Address - Fax:660-277-3526
Practice Address - Street 1:104 E ELM ST
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:MO
Practice Address - Zip Code:65259-1111
Practice Address - Country:US
Practice Address - Phone:660-277-4439
Practice Address - Fax:660-277-3526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-27
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0394573104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness