Organization
LIFE ENHANCEMENT VILLAGE OF BRANSON
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENNY ROGERS (CEO)
(417) 725-6680
Entity
Organization
Contact information
Practice address
421 OAK RIDGE RD, WALNUT SHADE, MO 65771-9173
(417) 561-5395
(417) 561-5395
Mailing address
421 OAK RIDGE RD, WALNUT SHADE, MO 65771-9173
(417) 561-5395
(417) 561-5395
Taxonomy
Speciality
Code
Description
License number
State
3104A0625X
Assisted Living Facility (Mental Illness)
Primary
0328545
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8611209
—
MO
Enumeration date
02/20/2008
Last updated
02/20/2008
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