Provider Demographics
NPI:1962810770
Name:ANNS PLACE
Entity type:Organization
Organization Name:ANNS PLACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-518-0444
Mailing Address - Street 1:P.O. BOX 481
Mailing Address - Street 2:
Mailing Address - City:PARK HILLS
Mailing Address - State:MO
Mailing Address - Zip Code:63601
Mailing Address - Country:US
Mailing Address - Phone:573-518-0444
Mailing Address - Fax:573-438-7230
Practice Address - Street 1:351 KEITH STREET
Practice Address - Street 2:
Practice Address - City:PARK HILLS
Practice Address - State:MO
Practice Address - Zip Code:63601
Practice Address - Country:US
Practice Address - Phone:573-518-0444
Practice Address - Fax:573-438-7230
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PEACH RESIDENTIAL CARE FACILITY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-07-24
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO042283310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility