Organization
SUNTERRA SPRINGFIELD OC, LLC
Active
Other names
Sunterra Springs Springfield
Organization subpart
No
Provider details
NPI number
Authorized official
RORY WILLIAMS (COO)
(801) 318-6476
Entity
Organization
Contact information
Practice address
4935 S NATIONAL AVE, SPRINGFIELD, MO 65810
(208) 523-3794
Mailing address
PO BOX 51298, IDAHO FALLS, ID 83405-1298
(208) 523-3794
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
265871
MEDICARE PROVIDER NUMBER
MO
01
—
FL001422355
STATE OF MISSOURI REGISTRATION
MO
Enumeration date
01/09/2018
Last updated
04/09/2019
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