Healthcare Provider Details

I. General information

NPI: 1982690871
Provider Name (Legal Business Name): MOORE-PIKE NURSING HOME INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2005
Last Update Date: 09/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 S SAINT CHARLES ST
BOWLING GREEN MO
63334-2221
US

IV. Provider business mailing address

300 S SAINT CHARLES ST
BOWLING GREEN MO
63334-2221
US

V. Phone/Fax

Practice location:
  • Phone: 573-324-5281
  • Fax: 573-324-6332
Mailing address:
  • Phone: 573-324-5281
  • Fax: 573-324-6332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number029652
License Number StateMO

VIII. Authorized Official

Name: MRS. MARTHA EARLENE MOORE
Title or Position: OWNER/ADMINISTRATOR
Credential:
Phone: 573-324-5281