Active NPI
PRC Enterprises, Inc.
- Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
- Poplar Bluff, MO
National Provider Identifier
1982804324
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
- Legal business name
- PRC ENTERPRISES, INC.
- Practice address
- 650 Vine St
Poplar Bluff, MO 63901-5039 - Phone
- (573) 778-1126
- Fax
- (573) 785-4887
- NPI assigned
- Jul 24, 2007
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Ms. Patricia Rose Campbell
- Title
- Owner
- Phone
- (573) 778-1126
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility | 320900000X | Primary |
Addresses
Primary practice location
650 Vine St
Poplar Bluff, MO 63901-5039
Mailing address
650 Vine St
Poplar Bluff, MO 63901-5039
Phone (573) 778-1126
Other names 1
- My Home
National Provider Directory
National Provider Directory- Tax ID family
- A1Care
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Intellectual & Developmental Disabilities Psychologist
- Poplar Bluff, MO
- NPI 1508925025
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1185235200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1189123200000",
"number": "1982804324",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "650 VINE ST",
"city": "POPLAR BLUFF",
"state": "MO",
"postal_code": "639015039",
"telephone_number": "573-778-1126",
"fax_number": "573-785-4887"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "650 VINE ST",
"city": "POPLAR BLUFF",
"state": "MO",
"postal_code": "639015039",
"telephone_number": "573-778-1126",
"fax_number": "573-785-4887"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PRC ENTERPRISES, INC.",
"organizational_subpart": "NO",
"enumeration_date": "2007-07-24",
"last_updated": "2007-09-07",
"status": "A",
"authorized_official_last_name": "CAMPBELL",
"authorized_official_first_name": "PATRICIA",
"authorized_official_middle_name": "ROSE",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "573-778-1126",
"authorized_official_name_prefix": "Ms."
},
"taxonomies": [
{
"code": "320900000X",
"taxonomy_group": "",
"desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "My Home",
"code": "3",
"type": "Doing Business As"
}
]
}
Other providers in Poplar Bluff, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.