Provider Demographics
NPI:1780252072
Name:RUSSELL FAMILY CARE CORP
Entity type:Organization
Organization Name:RUSSELL FAMILY CARE CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRANDE
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-854-4371
Mailing Address - Street 1:PO BOX 176
Mailing Address - Street 2:
Mailing Address - City:LESTERVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63654-0176
Mailing Address - Country:US
Mailing Address - Phone:573-854-4371
Mailing Address - Fax:
Practice Address - Street 1:510 E 2ND ST
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MO
Practice Address - Zip Code:63620-9104
Practice Address - Country:US
Practice Address - Phone:573-854-4371
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-14
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness