Healthcare Provider Details

I. General information

NPI: 1801880547
Provider Name (Legal Business Name): SALT RIVER NURSING HOME DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2005
Last Update Date: 02/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

142 SHELBY PLAZA RD
SHELBINA MO
63468-1065
US

IV. Provider business mailing address

142 SHELBY PLAZA RD
SHELBINA MO
63468-1065
US

V. Phone/Fax

Practice location:
  • Phone: 573-588-4175
  • Fax: 573-588-2020
Mailing address:
  • Phone: 573-588-4175
  • Fax: 573-588-2020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number030709
License Number StateMO

VIII. Authorized Official

Name: MRS. ELIZABETH YOUSE
Title or Position: ADMINISTRATOR
Credential:
Phone: 573-588-4175