Springfield Residential Center , Inc.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

SPRINGFIELD RESIDENTIAL CENTER , INC.

Practice address

2401 W Grand St
Springfield, MO 65802-4967

Phone

(417) 864-4545

Fax

(417) 864-4768

NPI assigned

Jul 1, 2006

Last updated

Dec 8, 2009By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Brian O. Mattox

Title

Administrator

Phone

(417) 864-4545

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Springfield Skilled Care Center Other name

Tax ID family

Springfield Healthcare Management LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Springfield Healthcare Management LLC

  • Skilled Nursing Facility
  • Springfield, MO
  • NPI 1700186939
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151712000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1260230400000",
    "number": "1184653297",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2401 W GRAND ST",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658024967",
            "telephone_number": "417-864-4545",
            "fax_number": "417-864-4768"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2401 W GRAND ST",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658024967",
            "telephone_number": "417-864-4545",
            "fax_number": "417-864-4768"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPRINGFIELD RESIDENTIAL CENTER , INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-01",
        "last_updated": "2009-12-08",
        "status": "A",
        "authorized_official_last_name": "MATTOX",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "O.",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "417-864-4545",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MO",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "102500303",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "262500309",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Springfield Skilled Care Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Springfield Physical Therapy & Rehabilitation Center Inc (Physical Therapy Clinic)
• Springfield Physical Therapy&Rehabilitation Ctr.Inc. (dba Physical Therapy Clinic)
• Springfield Psychiatry & Addiction Medicine LLC
• Springfield Psychological Services
• Springfield Public Schools R-12
• Springfield Smiles LLC
• Springfield Sport & Spine, LLC
• Nichole Sprowso, LCSW
• Cassandra E Spruill, ARNP
• Angela Nicole Spurgeon, D.O.

• Skilled Nursing Facility in Springfield, MO
• Providers in Springfield, MO by specialty
• Skilled Nursing Facility in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.