Provider Demographics
NPI:1467678474
Name:COATES STREET COMFORT HOUSE
Entity type:Organization
Organization Name:COATES STREET COMFORT HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:DUANE
Authorized Official - Last Name:BURKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-263-6759
Mailing Address - Street 1:612 W COATES ST
Mailing Address - Street 2:
Mailing Address - City:MOBERLY
Mailing Address - State:MO
Mailing Address - Zip Code:65270-1319
Mailing Address - Country:US
Mailing Address - Phone:660-263-6759
Mailing Address - Fax:660-263-0677
Practice Address - Street 1:612 WEST COATES ST
Practice Address - Street 2:
Practice Address - City:MOBERLY
Practice Address - State:MO
Practice Address - Zip Code:65270-1319
Practice Address - Country:US
Practice Address - Phone:660-263-6759
Practice Address - Fax:660-263-0677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO033516310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility