Coates Street Comfort House

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

033516 Issued in MO

Legal business name

COATES STREET COMFORT HOUSE

Practice address

612 West Coates St
Moberly, MO 65270-1319

Phone

(660) 263-6759

Fax

(660) 263-0677

NPI assigned

Apr 18, 2007

Last updated

Mar 20, 2008By 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. Randy Duane Burke

Title

Admin

Phone

(660) 263-6759

Specialties & licenses 1

Addresses

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

CLIA laboratory certificates

Locations

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

{
    "created_epoch": "1176854400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1205971200000",
    "number": "1467678474",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "612 W COATES ST",
            "city": "MOBERLY",
            "state": "MO",
            "postal_code": "652701319",
            "telephone_number": "660-263-6759",
            "fax_number": "660-263-0677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "612 WEST COATES ST",
            "city": "MOBERLY",
            "state": "MO",
            "postal_code": "652701319",
            "telephone_number": "660-263-6759",
            "fax_number": "660-263-0677"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COATES STREET COMFORT HOUSE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-18",
        "last_updated": "2008-03-20",
        "status": "A",
        "authorized_official_last_name": "BURKE",
        "authorized_official_first_name": "RANDY",
        "authorized_official_middle_name": "DUANE",
        "authorized_official_title_or_position": "ADMIN",
        "authorized_official_telephone_number": "660-263-6759",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "MO",
            "license": "033516",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Assisted Living Facility in Moberly, MO
• Providers in Moberly, MO by specialty
• Assisted Living Facility in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2008; 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.