Boulderwood Estates LLC
In Home Supportive Care in Nixa, MO. Organization (NPI-2).
NPI number1669928834
StatusActive
Last updated in NPPESAug 28, 2016
Details
- NPI
- 1669928834
- Entity type
- Organization (NPI-2)
- Legal business name
- Boulderwood Estates LLC
- Organization subpart
- No
- Enumeration date
- Aug 28, 2016
- Last updated
- Aug 28, 2016
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 253Z00000X | In Home Supportive Care | – | – | Yes |
Other names
- Boulderwood Estates (Doing Business As)
Practice location
1111 Care AveNixa, MO 65714-9679
Phone 417-374-7755
Mailing address
Po Box 870Nixa, MO 65714-0870
Authorized official
Kevin Edmonds
Member
4178601300
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