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Organization
INDEPENDENT LIVING CENTER OF SOUTHEAST MISSOURI
Active
Organization
INDEPENDENT LIVING CENTER OF SOUTHEAST MISSOURI
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JENNIFER BROWN (EXECUTIVE DIRECTOR)
(573) 686-2333
Entity
Organization
Contact information
Practice address
511 CEDAR ST, POPLAR BLUFF, MO 63901-7301
(573) 686-2333
(573) 686-1641
Mailing address
511 CEDAR ST, POPLAR BLUFF, MO 63901-7301
(573) 686-2333
(573) 686-1641
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
MO
253Z00000X
In Home Supportive Care Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
286211701
—
MO
Enumeration date
03/12/2007
Last updated
10/06/2021
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