Healthcare Provider Details

I. General information

NPI: 1053313932
Provider Name (Legal Business Name): MONROE COUNTY NURSING HOME DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 11/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 SOUTH ST
PARIS MO
65275-1165
US

IV. Provider business mailing address

200 SOUTH ST
PARIS MO
65275-1165
US

V. Phone/Fax

Practice location:
  • Phone: 660-327-4125
  • Fax: 660-327-5264
Mailing address:
  • Phone: 660-327-4125
  • Fax: 660-327-5264

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number314000000X
License Number StateMO

VIII. Authorized Official

Name: MRS. SHARI LYNNE EMBREE
Title or Position: ADMINISTRATOR
Credential:
Phone: 660-327-4125