Organization
LIFE ENHANCEMENT VILLAGE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENNY L ROGERS (CEO)
(417) 725-6680
Entity
Organization
Contact information
Practice address
732 S GREGG RD, NIXA, MO 65714-7419
(417) 725-6671
(417) 725-6671
Mailing address
732 S GREGG RD, NIXA, MO 65714-7419
(417) 725-6671
(417) 725-6671
Taxonomy
Speciality
Code
Description
License number
State
3104A0625X
Assisted Living Facility (Mental Illness)
Primary
032542
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3751109
—
MO
Enumeration date
02/22/2008
Last updated
02/22/2008
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