Pettis County Assisted Living, L.L.C.

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

PETTIS COUNTY ASSISTED LIVING, L.L.C.

Practice address

3017 Brooking Park Ave
Sedalia, MO 65301-9327

Phone

(660) 827-3222

Fax

(660) 829-2217

NPI assigned

Feb 15, 2016

Organization subpart

No

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

Authorized official

Name

Mr. Richard J Destefane

Title

President

Phone

(314) 543-3800

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1455494400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1455494400000",
    "number": "1568821965",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1869 CRAIG PARK CT",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631464122",
            "telephone_number": "314-543-3800",
            "fax_number": "314-543-3880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3017 BROOKING PARK AVE",
            "city": "SEDALIA",
            "state": "MO",
            "postal_code": "653019327",
            "telephone_number": "660-827-3222",
            "fax_number": "660-829-2217"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETTIS COUNTY ASSISTED LIVING, L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-15",
        "last_updated": "2016-02-15",
        "status": "A",
        "authorized_official_last_name": "DESTEFANE",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "314-543-3800",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3104A0625X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Mental Illness",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rodingson Ramos Perez, P.T.
• Perusich Chiropractic Associates, LLC (Backbone of Health)
• Michael R Perusich, DC
• Andrea Nicole Petersen, DNP, FNP
• Pettis County Ambulance District
• Pettis County Board of Services for the Developmentally Disabled
• Pettis County Health Center
• Pettis Emergency Group LLC
• Pettis Physician Services LLC
• Emma Pieper, DC

• Assisted Living Facility in Sedalia, MO
• Providers in Sedalia, 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 Feb 15, 2016; 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.