Healthcare Provider Details

I. General information

NPI: 1306906631
Provider Name (Legal Business Name): SCHUYLER COUNTY NURSING HOME DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1306 US HIGHWAY 63
QUEEN CITY MO
63561-2251
US

IV. Provider business mailing address

1306 US HIGHWAY 63
QUEEN CITY MO
63561-2251
US

V. Phone/Fax

Practice location:
  • Phone: 660-766-2291
  • Fax: 660-766-2884
Mailing address:
  • Phone: 660-766-2291
  • Fax: 660-766-2884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number031472
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number041379
License Number StateMO

VIII. Authorized Official

Name: MRS. MARCIA L MARTIN
Title or Position: ASSISTANT ADMINISTRATOR
Credential:
Phone: 660-766-2291