Organization
FIRST SERVE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RAYMOND JOSEPH STILL (DIRECTOR)
(417) 399-4847
Entity
Organization
Contact information
Practice address
115 E MAUPIN ST, BOLIVAR, MO 65613-2127
(417) 326-2272
(417) 326-2278
Mailing address
115 E MAUPIN ST, BOLIVAR, MO 65613-2127
(417) 326-2272
(417) 326-2278
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
09/25/2012
Last updated
09/25/2012
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