NPIMap

Organization Active NPI

Bristol Care, Inc.

  • Assisted Living Facility
  • Willard, MO
National Provider Identifier
1649486697
Registry record updated Oct 3, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
Legal business name
BRISTOL CARE, INC.
Practice address
511 Watson St
Willard, MO 65781-8314
Phone
(417) 742-0090
Fax
(417) 742-0090
NPI assigned
May 15, 2007
Last updated
Oct 3, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 3, 2007

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

Authorized official

Name
Shelley D Ebeling
Title
Medicaid Billing Department
Phone
(660) 826-0200

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X Primary

Addresses

Primary practice location

511 Watson St
Willard, MO 65781-8314

Mailing address

201 W 3Rd St
Sedalia, MO 65301-4352
Phone (660) 826-0200

Other names 1

  • Bristol Manor of Willard Other name

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
26D0962942Bristol Manor of Willard511 Watson, Willard, MO 65781Certificate of waiverJul 15, 2027

National Provider Directory

National Provider Directory
Tax ID family
Bristol Care Inc62 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1179187200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1191369600000",
    "number": "1649486697",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 W 3RD ST",
            "city": "SEDALIA",
            "state": "MO",
            "postal_code": "653014352",
            "telephone_number": "660-826-0200",
            "fax_number": "660-827-2027"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "511 WATSON ST",
            "city": "WILLARD",
            "state": "MO",
            "postal_code": "657818314",
            "telephone_number": "417-742-0090",
            "fax_number": "417-742-0090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRISTOL CARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-15",
        "last_updated": "2007-10-03",
        "status": "A",
        "authorized_official_last_name": "EBELING",
        "authorized_official_first_name": "SHELLEY",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "MEDICAID BILLING DEPARTMENT",
        "authorized_official_telephone_number": "660-826-0200"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bristol Manor of Willard",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Willard, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2007; 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.