NPIMap

Bristol Care, Inc.

Organization Active NPI Assisted Living Facility · Maysville, MO

NPI 1164638409 · NPPES record last updated Oct 3, 2007

Key facts

NPI
1164638409
Entity type
Organization (NPI type 2)
Primary specialty
Assisted Living Facility 310400000X
Legal business name
BRISTOL CARE, INC.
Practice address
604 S Polk St
Maysville, MO 64469-4033
Phone
(816) 449-2741
Fax
(816) 449-2741
NPI assigned
May 15, 2007
Organization subpart
No

Authorized official

Name
Shelley D Ebeling
Title
Medicaid Billing Department
Phone
(660) 826-0200

Corporate family (same tax ID) 21

Organizations that report the same tax identification number in the National Provider Directory.

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
26D0949758Bristol Manor of Maysville
604 South Polk, Maysville, MO 64469		Certificate of waiverAug 9, 2026

National Provider Directory

Tax ID family
Bristol Care Inc (62 organizations share this tax ID)

Locations

604 S Polk St
Maysville, MO 64469
Phone (816) 449-2741

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X Yes

Addresses

Primary practice location

604 S Polk St
Maysville, MO 64469-4033

Mailing address

201 W 3Rd St
Sedalia, MO 65301-4352
Phone (660) 826-0200

Other names

  • Bristol Manor of Maysville Other name

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Oct 3, 2007.

{
    "created_epoch": "1179187200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1191369600000",
    "number": "1164638409",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 W 3RD ST",
            "city": "SEDALIA",
            "state": "MO",
            "postal_code": "653014352",
            "telephone_number": "660-826-0200",
            "fax_number": "660-827-2027"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "604 S POLK ST",
            "city": "MAYSVILLE",
            "state": "MO",
            "postal_code": "644694033",
            "telephone_number": "816-449-2741",
            "fax_number": "816-449-2741"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRISTOL CARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-15",
        "last_updated": "2007-10-03",
        "status": "A",
        "authorized_official_last_name": "EBELING",
        "authorized_official_first_name": "SHELLEY",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "MEDICAID BILLING DEPARTMENT",
        "authorized_official_telephone_number": "660-826-0200"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bristol Manor of Maysville",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Maysville, MO

All providers in Maysville, MO · Assisted Living Facility in Missouri

Sources for this page

Verify at the official NPI Registry.