Provider Demographics
NPI:1063763407
Name:FIRST SERVE LLC
Entity type:Organization
Organization Name:FIRST SERVE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:STILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-399-4847
Mailing Address - Street 1:115 E MAUPIN ST
Mailing Address - Street 2:
Mailing Address - City:BOLIVAR
Mailing Address - State:MO
Mailing Address - Zip Code:65613-2127
Mailing Address - Country:US
Mailing Address - Phone:417-326-2272
Mailing Address - Fax:417-326-2278
Practice Address - Street 1:115 E MAUPIN ST
Practice Address - Street 2:
Practice Address - City:BOLIVAR
Practice Address - State:MO
Practice Address - Zip Code:65613-2127
Practice Address - Country:US
Practice Address - Phone:417-326-2272
Practice Address - Fax:417-326-2278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-25
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No251E00000XAgenciesHome Health