Healthcare Provider Details

I. General information

NPI: 1295019545
Provider Name (Legal Business Name): AMERICARE AT HERITAGE HALL NURSING CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2011
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 E HIGHWAY 22
CENTRALIA MO
65240-1146
US

IV. Provider business mailing address

750 E HIGHWAY 22
CENTRALIA MO
65240-1146
US

V. Phone/Fax

Practice location:
  • Phone: 573-682-5551
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: KYLE TIMOTHY SCHADE
Title or Position: PRESIDENT
Credential:
Phone: 573-471-1113