Healthcare Provider Details

I. General information

NPI: 1821179789
Provider Name (Legal Business Name): COUNTRY MEADOWS NURSING & REHAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 08/13/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 NORTH SAINT JOE DRIVE
PARK HILLS MO
63601-1965
US

IV. Provider business mailing address

1301 NORTH SAINT JOE DRIVE
PARK HILLS MO
63601-1965
US

V. Phone/Fax

Practice location:
  • Phone: 573-431-2889
  • Fax: 573-431-2822
Mailing address:
  • Phone: 573-431-2889
  • Fax: 573-431-2822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number032558
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number032557
License Number StateMO

VIII. Authorized Official

Name: CARLA HEDRICK
Title or Position: CFO
Credential:
Phone: 573-481-9625