Life Enhancement Village of Branson

Primary specialty

Assisted Living Facility (Mental Illness)Taxonomy code 3104A0625X

License

0328545 Issued in MO

Legal business name

LIFE ENHANCEMENT VILLAGE OF BRANSON

Practice address

421 Oak Ridge Rd
Walnut Shade, MO 65771-9173

Phone

(417) 561-5395

Fax

(417) 561-5395

NPI assigned

Feb 20, 2008

Last updated

Feb 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

Kenny Rogers

Title

Ceo

Phone

(417) 725-6680

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

Life Enhancement Village3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

• Life Enhancement Village

  • Assisted Living Facility (Mental Illness)
  • Nixa, MO
  • NPI 1538338652
  NPD tax ID
• Life Enhancement Village of the Ozarks, Inc.

  • Assisted Living Facility (Mental Illness)
  • Nixa, MO
  • NPI 1841474871
  NPD tax ID

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

{
    "created_epoch": "1203465600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1203465600000",
    "number": "1689842916",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "421 OAK RIDGE RD",
            "city": "WALNUT SHADE",
            "state": "MO",
            "postal_code": "657719173",
            "telephone_number": "417-561-5395",
            "fax_number": "417-561-5395"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "421 OAK RIDGE RD",
            "city": "WALNUT SHADE",
            "state": "MO",
            "postal_code": "657719173",
            "telephone_number": "417-561-5395",
            "fax_number": "417-561-5395"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE ENHANCEMENT VILLAGE OF BRANSON",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-20",
        "last_updated": "2008-02-20",
        "status": "A",
        "authorized_official_last_name": "ROGERS",
        "authorized_official_first_name": "KENNY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "417-725-6680"
    },
    "taxonomies": [
        {
            "code": "3104A0625X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Mental Illness",
            "state": "MO",
            "license": "0328545",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8611209",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• 4-Acres Inc Dba Forakers Summerhouse
• Kyla Bonillas, COTA/L
• Brandon L Bressler, PA-S
• Kinsey Vogt, FNP-C

• Assisted Living Facility (Mental Illness) in Walnut Shade, MO
• Providers in Walnut Shade, 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 Feb 20, 2008; 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.