Basic Information
| Provider Information | |||||||||
| NPI: | 1487011649 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MARSHFIELD PLACE LLC | ||||||||
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| OtherOrganizationName: | MARSHFIELD PLACE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 820 S WHITE OAK RD | ||||||||
| Address2: | |||||||||
| City: | MARSHFIELD | ||||||||
| State: | MO | ||||||||
| PostalCode: | 657062231 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 820 S WHITE OAK RD | ||||||||
| Address2: | |||||||||
| City: | MARSHFIELD | ||||||||
| State: | MO | ||||||||
| PostalCode: | 657062231 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4178596133 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/19/2016 | ||||||||
| LastUpdateDate: | 01/19/2016 | ||||||||
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| AuthorizedOfficialLastName: | WOODWORTH | ||||||||
| AuthorizedOfficialFirstName: | TIMOTHY | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 4178274210 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 311Z00000X | 043507 | MO | Y | Nursing & Custodial Care Facilities | Custodial Care Facility |
No ID Information.