Organization
MEDICALODGES, INC.
Active
Other names
Gran Villas Neosho
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CATHY W FISHER (CHIEF FINANCIAL OFFICER)
(620) 251-6700
Entity
Organization
Contact information
Practice address
420 W LYON DR, NEOSHO, MO 64850-9194
(417) 451-7071
(417) 451-5127
Mailing address
420 W LYON DR, NEOSHO, MO 64850-9194
(417) 451-7071
(417) 451-5127
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
031639
MO
261QA0600X
Adult Day Care Clinic/Center
Primary
031639
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
031639
—
MO
05
—
268025509
—
MO
Enumeration date
11/08/2006
Last updated
04/19/2011
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