Provider Demographics
NPI:1245893296
Name:MICHELE VINSON INVESTMENTS LLC DBA BOLIVAR MANOR HOUSE
Entity type:Organization
Organization Name:MICHELE VINSON INVESTMENTS LLC DBA BOLIVAR MANOR HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:RUTHANNE
Authorized Official - Last Name:VINSON
Authorized Official - Suffix:
Authorized Official - Credentials:MEMBER
Authorized Official - Phone:417-327-5790
Mailing Address - Street 1:PO BOX 175
Mailing Address - Street 2:
Mailing Address - City:BOLIVAR
Mailing Address - State:MO
Mailing Address - Zip Code:65613-0175
Mailing Address - Country:US
Mailing Address - Phone:417-327-5790
Mailing Address - Fax:417-326-3839
Practice Address - Street 1:404 E BROADWAY ST
Practice Address - Street 2:
Practice Address - City:BOLIVAR
Practice Address - State:MO
Practice Address - Zip Code:65613-2019
Practice Address - Country:US
Practice Address - Phone:417-327-5790
Practice Address - Fax:417-326-3839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-16
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness