Provider Demographics
NPI:1881753093
Name:REGIONAL PRIVATE HEALTH SERVICES INC
Entity type:Organization
Organization Name:REGIONAL PRIVATE HEALTH SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:DAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:1319-835-3933
Mailing Address - Street 1:RR 1 BOX 16B
Mailing Address - Street 2:
Mailing Address - City:KAHOKA
Mailing Address - State:MO
Mailing Address - Zip Code:63445-9650
Mailing Address - Country:US
Mailing Address - Phone:660-727-9040
Mailing Address - Fax:660-727-2620
Practice Address - Street 1:RR 1 BOX 16B
Practice Address - Street 2:
Practice Address - City:KAHOKA
Practice Address - State:MO
Practice Address - Zip Code:63445-9650
Practice Address - Country:US
Practice Address - Phone:660-727-9040
Practice Address - Fax:660-727-2620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO268851102Medicaid
MO288851108Medicaid