Healthcare Provider Details

I. General information

NPI: 1790770444
Provider Name (Legal Business Name): GOLDEN AGE NURSING HOME DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2005
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 E 3RD ST
STOVER MO
65078-0947
US

IV. Provider business mailing address

PO BOX 307
STOVER MO
65078-0307
US

V. Phone/Fax

Practice location:
  • Phone: 573-377-4521
  • Fax: 573-377-2153
Mailing address:
  • Phone: 573-377-4521
  • Fax: 573-377-2153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number031356
License Number StateMO

VIII. Authorized Official

Name: DONNA JEAN BOWERS
Title or Position: ADMINISTRATOR
Credential:
Phone: 573-377-4521