Organization
ALPHA ASSISTED LIVING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LEAETTA M GARDNER LPN, ADM. (ADM.)
(573) 341-8000
Entity
Organization
Contact information
Practice address
13450 CR 7040, 803 E 12TH ST, ROLLA, MO 65401
(573) 341-8000
(573) 341-2222
Mailing address
13450 COUNTY ROAD 7040, ALPHA ASSISTED LIVING, LLC, ROLLA, MO 65401
(573) 341-8000
(573) 341-2222
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
042404
—
MO
Enumeration date
10/26/2016
Last updated
10/26/2016
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