Provider Demographics
NPI:1932758125
Name:PROACTIVE HOME CARE MISSOURI
Entity Type:Organization
Organization Name:PROACTIVE HOME CARE MISSOURI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SADIE
Authorized Official - Middle Name:K
Authorized Official - Last Name:MUSICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-380-3829
Mailing Address - Street 1:104B W MOUNT VERNON BLVD
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:MO
Mailing Address - Zip Code:65712-1936
Mailing Address - Country:US
Mailing Address - Phone:417-850-2013
Mailing Address - Fax:417-855-2242
Practice Address - Street 1:104B W MOUNT VERNON BLVD
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:MO
Practice Address - Zip Code:65712-1936
Practice Address - Country:US
Practice Address - Phone:417-850-2013
Practice Address - Fax:417-855-2242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-10
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty