South Haven Residential Care LLC

Primary specialty

Assisted Living Facility (Mental Illness)Taxonomy code 3104A0625X

License

033284 Issued in MO

Legal business name

SOUTH HAVEN RESIDENTIAL CARE LLC

Practice address

10462 Airport Rd
Mineral Point, MO 63660-9325

Phone

(573) 438-4150

Fax

(573) 438-4156

NPI assigned

Mar 26, 2007

Last updated

Aug 22, 2020By 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

Patricia Anderson

Title

Secretary

Phone

(573) 546-1616

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1174867200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1538286265",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "231 S MAIN ST",
            "address_2": "SUITE B",
            "city": "IRONTON",
            "state": "MO",
            "postal_code": "636501307",
            "telephone_number": "573-546-1616",
            "fax_number": "573-546-6465"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10462 AIRPORT RD",
            "city": "MINERAL POINT",
            "state": "MO",
            "postal_code": "636609325",
            "telephone_number": "573-438-4150",
            "fax_number": "573-438-4156"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH HAVEN RESIDENTIAL CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-26",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "PATRICIA",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "573-546-1616"
    },
    "taxonomies": [
        {
            "code": "3104A0625X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Mental Illness",
            "state": "MO",
            "license": "033284",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Casey Eaton, FNP-BC
• Great Mines Health Center
• Hillside Living Center LLC
• Anthony J Mingo, EMT-CP, CHW-C
• South Haven Residential Care Center, LLC
• Transition-Ready Services
• Washington County Ambulance District

• Assisted Living Facility (Mental Illness) in Mineral Point, MO
• Providers in Mineral Point, MO by specialty
• Assisted Living Facility (Mental Illness) in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.