Provider Demographics
NPI:1730963265
Name:CROSSTREE HAMPTON HOUSE LLC
Entity type:Organization
Organization Name:CROSSTREE HAMPTON HOUSE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-217-8669
Mailing Address - Street 1:1287 W NORTH ST
Mailing Address - Street 2:
Mailing Address - City:PIGGOTT
Mailing Address - State:AR
Mailing Address - Zip Code:72454-1010
Mailing Address - Country:US
Mailing Address - Phone:573-217-8669
Mailing Address - Fax:
Practice Address - Street 1:201 N DECATUR ST
Practice Address - Street 2:
Practice Address - City:MALDEN
Practice Address - State:MO
Practice Address - Zip Code:63863-2017
Practice Address - Country:US
Practice Address - Phone:573-276-6054
Practice Address - Fax:573-276-5928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-24
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness