Healthcare Provider Details

I. General information

NPI: 1649242876
Provider Name (Legal Business Name): GRUNDY COUNTY NURSING HOME DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1311 E 28TH ST
TRENTON MO
64683
US

IV. Provider business mailing address

1311 E 28TH ST
TRENTON MO
64683
US

V. Phone/Fax

Practice location:
  • Phone: 660-359-5647
  • Fax: 660-359-4111
Mailing address:
  • Phone: 660-359-5647
  • Fax: 660-359-4111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number035512
License Number State

VIII. Authorized Official

Name: MRS. PATRISHA SMITH
Title or Position: ADMINISTRATOR
Credential: LNHA
Phone: 660-359-5647