Provider Demographics
NPI:1457424590
Name:MARK TWAIN ASSISTED LIVING INC.
Entity Type:Organization
Organization Name:MARK TWAIN ASSISTED LIVING INC.
Other - Org Name:MARK TWAIN OF HUNTSVILLE
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:L
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-263-6515
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:
Practice Address - Street 1:901 UNION AVE
Practice Address - Street 2:
Practice Address - City:MOBERLY
Practice Address - State:MO
Practice Address - Zip Code:65270-2456
Practice Address - Country:US
Practice Address - Phone:660-263-6515
Practice Address - Fax:660-263-0603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0364073104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness