Provider Demographics
NPI:1477644714
Name:MLD HEALTHCARE LLC
Entity type:Organization
Organization Name:MLD HEALTHCARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PERSIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MELVIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:DUNSWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-632-7254
Mailing Address - Street 1:801 EUCLID AVE
Mailing Address - Street 2:PO BOX 438
Mailing Address - City:CAMERON
Mailing Address - State:MO
Mailing Address - Zip Code:64429-2003
Mailing Address - Country:US
Mailing Address - Phone:816-632-7254
Mailing Address - Fax:816-632-3757
Practice Address - Street 1:801 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CAMERON
Practice Address - State:MO
Practice Address - Zip Code:64429-2003
Practice Address - Country:US
Practice Address - Phone:816-632-7254
Practice Address - Fax:816-632-3757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO032592314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO90769013OtherBC/BS PROVIDER NUMBER
MO90769013OtherBC/BS PROVIDER NUMBER