Provider Demographics
NPI:1285621185
Name:DAVIS MANAGEMENT SERVICES, INC.
Entity type:Organization
Organization Name:DAVIS MANAGEMENT SERVICES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MCGHEE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:660-535-4325
Mailing Address - Street 1:300 WEST FAIRVIEW STREET
Mailing Address - Street 2:
Mailing Address - City:KING CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64463-0605
Mailing Address - Country:US
Mailing Address - Phone:660-535-4325
Mailing Address - Fax:660-535-4553
Practice Address - Street 1:300 WEST FAIRVIEW STREET
Practice Address - Street 2:
Practice Address - City:KING CITY
Practice Address - State:MO
Practice Address - Zip Code:64463-0605
Practice Address - Country:US
Practice Address - Phone:660-535-4325
Practice Address - Fax:660-535-4553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-05
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO041609314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO101488807Medicaid
MO101488807Medicaid