Healthcare Provider Details

I. General information

NPI: 1194649830
Provider Name (Legal Business Name): SCOTLAND COUNTY NURSING HOME DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

434 E SIGLER AVE
MEMPHIS MO
63555-1714
US

IV. Provider business mailing address

434 E SIGLER AVE
MEMPHIS MO
63555-1714
US

V. Phone/Fax

Practice location:
  • Phone: 660-465-7221
  • Fax: 660-465-7224
Mailing address:
  • Phone: 660-465-7221
  • Fax: 660-465-7224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. STEPHANIE GRACE KETCHUM
Title or Position: ADMINISTRATOR
Credential:
Phone: 660-465-7221