Organization
INDEPENDENCE 1 INC
Active
Other names
Maywood Terrace Living Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DONALD B BEDELL (PRESIDENT)
(573) 471-1276
Entity
Organization
Contact information
Practice address
10300 E TRUMAN RD, INDEPENDENCE, MO 64052-2258
(816) 836-1250
Mailing address
PO BOX 1210, SIKESTON, MO 63801-1210
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
045861
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101498004
—
MO
Enumeration date
07/07/2006
Last updated
12/13/2017
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