Organization
MOUNTAIN GROVE 2 INC
Active
Other names
Autumn Oaks Caring Center
Organization subpart
No
Provider details
NPI number
Authorized official
DONALD B BEDELL (PRESIDENT)
(573) 471-1276
Entity
Organization
Contact information
Practice address
1310 N HOVIS ST, MOUNTAIN GROVE, MO 65711-1219
(417) 926-5128
Mailing address
731 N MAIN ST, PO BOX 1210, SIKESTON, MO 63801-2151
(573) 471-1276
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
044753
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101472603
—
MO
Enumeration date
07/07/2006
Last updated
04/30/2021
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