Healthcare Provider Details

I. General information

NPI: 1356338941
Provider Name (Legal Business Name): LA PLATA NURSING HOME DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 08/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 OLD STAGECOACH RD
LA PLATA MO
63549-1362
US

IV. Provider business mailing address

100 OLD STAGECOACH RD
LA PLATA MO
63549-1362
US

V. Phone/Fax

Practice location:
  • Phone: 660-332-4315
  • Fax: 660-332-7436
Mailing address:
  • Phone: 660-332-4315
  • Fax: 660-332-7436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number031728
License Number StateMO

VIII. Authorized Official

Name: MS. DEBBIE CAIN
Title or Position: ADMINISTRATOR
Credential:
Phone: 660-332-4315