Provider Demographics
NPI:1881181170
Name:IRONTON RESIDENTIAL CARE, LLC
Entity type:Organization
Organization Name:IRONTON RESIDENTIAL CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:EILEEN
Authorized Official - Last Name:VEACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-330-3760
Mailing Address - Street 1:PO BOX 272
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63640-0272
Mailing Address - Country:US
Mailing Address - Phone:573-330-3760
Mailing Address - Fax:
Practice Address - Street 1:101 S KNOB ST
Practice Address - Street 2:
Practice Address - City:IRONTON
Practice Address - State:MO
Practice Address - Zip Code:63650-1501
Practice Address - Country:US
Practice Address - Phone:573-546-3080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-23
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness