NPIMap

Organization Active NPI

Medicalodges, Inc.

Doing business as Gran Villas Neosho

  • Adult Day Care Clinic/Center
  • Neosho, MO
National Provider Identifier
1316017544
Registry record updated Apr 19, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Day Care Clinic/CenterTaxonomy code 261QA0600X
License
031639 Issued in MO
Legal business name
MEDICALODGES, INC.
Doing business as
Gran Villas Neosho
Practice address
420 W Lyon Dr
Neosho, MO 64850-9194
Phone
(417) 451-7071
Fax
(417) 451-5127
NPI assigned
Nov 8, 2006
Last updated
Apr 19, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 19, 2011

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

Authorized official

Name
Ms. Cathy W Fisher
Title
Chief Financial Officer
Phone
(620) 251-6700

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X 031639 MO
Adult Day Care Clinic/Center 261QA0600X 031639 MO Primary

Addresses

Primary practice location

420 W Lyon Dr
Neosho, MO 64850-9194

Mailing address

420 W Lyon Dr
Neosho, MO 64850-9194
Phone (417) 451-7071

Other identifiers 2

IdentifierTypeStateIssuer
031639MedicaidMO
268025509MedicaidMO

Other names 1

  • Gran Villas Neosho Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
26D0955662Gran Villas,the420 Lyon Drive, Neosho, MO 64850Certificate of waiverJan 5, 2027

National Provider Directory

National Provider Directory
Tax ID family
Medicalodges Inc47 organizations share this tax ID, including this one

Other organizations with this tax ID 46

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

View all 46

NPI Registry JSON

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

{
    "created_epoch": "1162944000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1303171200000",
    "number": "1316017544",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "420 W LYON DR",
            "city": "NEOSHO",
            "state": "MO",
            "postal_code": "648509194",
            "telephone_number": "417-451-7071",
            "fax_number": "417-451-5127"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 W LYON DR",
            "city": "NEOSHO",
            "state": "MO",
            "postal_code": "648509194",
            "telephone_number": "417-451-7071",
            "fax_number": "417-451-5127"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICALODGES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-08",
        "last_updated": "2011-04-19",
        "status": "A",
        "authorized_official_last_name": "FISHER",
        "authorized_official_first_name": "CATHY",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "620-251-6700",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "MO",
            "license": "031639",
            "primary": false
        },
        {
            "code": "261QA0600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Day Care",
            "state": "MO",
            "license": "031639",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "031639",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "268025509",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Gran Villas Neosho",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Neosho, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.