Provider Demographics
NPI:1457334880
Name:PRIMROSE PLACE INC
Entity Type:Organization
Organization Name:PRIMROSE PLACE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RON
Authorized Official - Middle Name:
Authorized Official - Last Name:PRENGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-269-9010
Mailing Address - Street 1:1115 E PRIMROSE ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-5146
Mailing Address - Country:US
Mailing Address - Phone:417-269-9010
Mailing Address - Fax:417-269-9966
Practice Address - Street 1:1115 E PRIMROSE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-5146
Practice Address - Country:US
Practice Address - Phone:417-269-9010
Practice Address - Fax:417-269-9966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-21
Last Update Date:2009-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO030605314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO106915705Medicaid
MO265559Medicare Oscar/Certification