Basic Information
| Provider Information | |||||||||
| NPI: | 1497133243 | ||||||||
| 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: | 1212 E STATE ROUTE 72 | ||||||||
| Address2: | SUITE 8 | ||||||||
| City: | ROLLA | ||||||||
| State: | MO | ||||||||
| PostalCode: | 654013938 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5733083400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/13/2015 | ||||||||
| LastUpdateDate: | 05/13/2015 | ||||||||
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| AuthorizedOfficialLastName: | GOSS | ||||||||
| AuthorizedOfficialFirstName: | BONTIEA | ||||||||
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| AuthorizedOfficialTitleorPosition: | COO | ||||||||
| AuthorizedOfficialTelephone: | 4178698911 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 320900000X | CC01430115 | MO | Y | Residential Treatment Facilities | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities |
No ID Information.