Organization
SOUTHAVEN INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. GINA DAWN STOVERINK (OWNER ADMINISTRATOR)
(573) 888-9213
Entity
Organization
Contact information
Practice address
612 SOUTH BY-PASS, KENNETT, MO 63857
(573) 888-9213
(573) 888-9218
Mailing address
612 SOUTH BY-PASS, KENNETT, MO 63857
(573) 888-9213
(573) 888-9218
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
033614
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
266179704
—
MO
Enumeration date
03/26/2007
Last updated
07/07/2008
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