Provider Demographics
NPI:1982831996
Name:SPRINGFIELD HEALTHCARE CENTER LLC
Entity Type:Organization
Organization Name:SPRINGFIELD HEALTHCARE CENTER LLC
Other - Org Name:SPRINGFIELD SKILLED CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:W
Authorized Official - Last Name:REDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-415-9700
Mailing Address - Street 1:9420 LIBERTY DR
Mailing Address - Street 2:
Mailing Address - City:PLEASANT VALLEY
Mailing Address - State:MO
Mailing Address - Zip Code:64068-7757
Mailing Address - Country:US
Mailing Address - Phone:816-415-9700
Mailing Address - Fax:816-415-9770
Practice Address - Street 1:2401 W GRAND ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65802-4967
Practice Address - Country:US
Practice Address - Phone:417-864-4545
Practice Address - Fax:417-869-4524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-17
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO036662314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO102500303Medicaid
MO102500303Medicaid