Healthcare Provider Details

I. General information

NPI: 1982690376
Provider Name (Legal Business Name): CURRENT RIVER NURSING CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2005
Last Update Date: 11/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 N GRAND AVE
DONIPHAN MO
63935-1779
US

IV. Provider business mailing address

1015 N GRAND AVE
DONIPHAN MO
63935-1779
US

V. Phone/Fax

Practice location:
  • Phone: 573-996-4239
  • Fax: 573-996-4242
Mailing address:
  • Phone: 573-996-4239
  • Fax: 573-996-4242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number030141
License Number StateMO

VIII. Authorized Official

Name: JAMES C LINCOLN
Title or Position: SHAREHOLDER
Credential:
Phone: 573-746-7100