Healthcare Provider Details

I. General information

NPI: 1487132890
Provider Name (Legal Business Name): WINCHESTER NURSING CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2018
Last Update Date: 12/27/2022
Certification Date: 12/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 WINCHESTER ROAD
BERNIE MO
63822-0760
US

IV. Provider business mailing address

PO BOX 760
BERNIE MO
63822-0760
US

V. Phone/Fax

Practice location:
  • Phone: 573-293-6705
  • Fax:
Mailing address:
  • Phone: 573-293-6705
  • Fax: 573-293-6710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. BENJAMIN PACK SELLS
Title or Position: OWNER
Credential:
Phone: 573-614-7472