Basic Information
| Provider Information | |||||||||
| NPI: | 1730841230 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MARSHFIELD HEALTHCARE LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 110 ROCKAWAY TPKE STE 6 | ||||||||
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| City: | LAWRENCE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115591626 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 800 S WHITE OAK RD | ||||||||
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| City: | MARSHFIELD | ||||||||
| State: | MO | ||||||||
| PostalCode: | 657062231 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4178593701 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2021 | ||||||||
| LastUpdateDate: | 10/12/2021 | ||||||||
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| AuthorizedOfficialLastName: | PERLOW | ||||||||
| AuthorizedOfficialFirstName: | BERNARD | ||||||||
| AuthorizedOfficialMiddleName: | DAVID | ||||||||
| AuthorizedOfficialTitleorPosition: | AUTHORIZED OFFICIAL | ||||||||
| AuthorizedOfficialTelephone: | 4439283278 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 09/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.