Provider Demographics
NPI:1851915706
Name:ALBANY PLACE LLC
Entity type:Organization
Organization Name:ALBANY PLACE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELBA
Authorized Official - Middle Name:NADINE
Authorized Official - Last Name:MANDRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-777-8040
Mailing Address - Street 1:PO BOX 176
Mailing Address - Street 2:
Mailing Address - City:BOLIVAR
Mailing Address - State:MO
Mailing Address - Zip Code:65613-0176
Mailing Address - Country:US
Mailing Address - Phone:417-777-8040
Mailing Address - Fax:417-777-3024
Practice Address - Street 1:520 S ALBANY AVE
Practice Address - Street 2:
Practice Address - City:BOLIVAR
Practice Address - State:MO
Practice Address - Zip Code:65613-2116
Practice Address - Country:US
Practice Address - Phone:417-777-8040
Practice Address - Fax:417-777-3024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-05
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health