Organization
SPRINGFIELD RESIDENTIAL CENTER , INC.
Active
Other names
Springfield Skilled Care Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRIAN O. MATTOX (ADMINISTRATOR)
(417) 864-4545
Entity
Organization
Contact information
Practice address
2401 W GRAND ST, SPRINGFIELD, MO 65802-4967
(417) 864-4545
(417) 864-4768
Mailing address
2401 W GRAND ST, SPRINGFIELD, MO 65802-4967
(417) 864-4545
(417) 864-4768
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102500303
—
MO
05
—
262500309
—
MO
Enumeration date
07/01/2006
Last updated
12/08/2009
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