Basic Information
| Provider Information | |||||||||
| NPI: | 1326426065 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PREFERRED FAMILY HEALTHCARE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1111 S GLENSTONE AVE | ||||||||
| Address2: | SUITE 3-100 | ||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MO | ||||||||
| PostalCode: | 658040338 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 429 E WALNUT ST | ||||||||
| Address2: | |||||||||
| City: | NEVADA | ||||||||
| State: | MO | ||||||||
| PostalCode: | 647722457 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4176674638 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/14/2015 | ||||||||
| LastUpdateDate: | 07/29/2022 | ||||||||
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| AuthorizedOfficialLastName: | CONOVER | ||||||||
| AuthorizedOfficialFirstName: | MARK | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF REVENUE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 5736031460 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 07/29/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251C00000X | CC01430115 | MO | Y | Agencies | Day Training, Developmentally Disabled Services |
No ID Information.