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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