Healthcare Provider Details

I. General information

NPI: 1982665717
Provider Name (Legal Business Name): GIDEON CARE CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 05/02/2024
Certification Date: 05/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 S LUNBECK AVE
GIDEON MO
63848-9211
US

IV. Provider business mailing address

PO BOX 197 FOURTH & LUNBECK
GIDEON MO
63848-0197
US

V. Phone/Fax

Practice location:
  • Phone: 573-448-3505
  • Fax: 573-448-3787
Mailing address:
  • Phone: 573-448-3505
  • Fax: 573-448-3787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number031090
License Number StateMO

VIII. Authorized Official

Name: MRS. ANGELA RENEE JONES
Title or Position: ADMINISTRATOR
Credential: OWNER
Phone: 573-448-3505