Provider Demographics
NPI:1447814538
Name:PATRICIAS RESIDENTIAL CARE FACILITY INC
Entity type:Organization
Organization Name:PATRICIAS RESIDENTIAL CARE FACILITY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:ALCORN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-598-4202
Mailing Address - Street 1:301 B HWY HH
Mailing Address - Street 2:
Mailing Address - City:PIEDMONT
Mailing Address - State:MO
Mailing Address - Zip Code:63957
Mailing Address - Country:US
Mailing Address - Phone:573-223-2754
Mailing Address - Fax:573-223-7589
Practice Address - Street 1:510 E 2ND ST
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MO
Practice Address - Zip Code:63620-9104
Practice Address - Country:US
Practice Address - Phone:573-958-4202
Practice Address - Fax:573-598-3885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-24
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility