MEDICARE: CARROLL HOUSE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	029457	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	17206936	OTHER	MO	STATE ID

General Provider Information

NPI Number	:	1346236791
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARROLL HOUSE, INC.

Provider Business Mailing Address
First Line	:	306 GRAND AVE
Second Line	:
City	:	CARROLLTON
State	:	MO
Zip	:	64633-2203
Country	:	US
Telephone Number	:	660-542-1599
Fax Number	:	660-542-3241

Provider Business Practice Location Address
First Line	:	306 GRAND AVE
Second Line	:
City	:	CARROLLTON
State	:	MO
Zip	:	64633-2203
Country	:	US
Telephone Number	:	660-542-1599
Fax Number	:	660-542-3241

Authorized Official
Title or Position	:	CFO
Name	:	CARLA HEDRICK
Credential	:	CFO
Telephone Number	:	573-481-9625

Provider Enumeration Date	:	09/21/2005
Last Update Date	:	09/15/2025

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Directions to “CARROLL HOUSE, INC. ” Practice Location

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