Healthcare Provider Details

I. General information

NPI: 1659363224
Provider Name (Legal Business Name): CLINTON CONVALESCENT CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 02/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 E CLAY AVE
PLATTSBURG MO
64477-8100
US

IV. Provider business mailing address

PO BOX 247 205 E. CLAY AVE.
PLATTSBURG MO
64477-0247
US

V. Phone/Fax

Practice location:
  • Phone: 816-539-2128
  • Fax: 816-539-2715
Mailing address:
  • Phone: 816-539-2128
  • Fax: 816-539-2715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number030633
License Number StateMO

VIII. Authorized Official

Name: ELIZABETH JONES
Title or Position: ADMINISTRATOR
Credential:
Phone: 816-539-2128