Provider Demographics
NPI:1912696865
Name:CHRISTIAN SERVANTS HOME CARE MISSOURI, LLC
Entity Type:Organization
Organization Name:CHRISTIAN SERVANTS HOME CARE MISSOURI, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:IVERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-281-7965
Mailing Address - Street 1:W5866 EASTER LILY DR
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54915-7273
Mailing Address - Country:US
Mailing Address - Phone:262-939-0894
Mailing Address - Fax:
Practice Address - Street 1:W5866 EASTER LILY DR
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54915-7273
Practice Address - Country:US
Practice Address - Phone:715-281-7965
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-05
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care