Healthcare Provider Details

I. General information

NPI: 1881835528
Provider Name (Legal Business Name): PUTNAM COUNTY NURSING HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2009
Last Update Date: 03/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1814 OAK ST
UNIONVILLE MO
63565-1275
US

IV. Provider business mailing address

1814 OAK ST
UNIONVILLE MO
63565-1275
US

V. Phone/Fax

Practice location:
  • Phone: 660-947-2492
  • Fax:
Mailing address:
  • Phone: 660-947-2492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number036509
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number06516
License Number StateMO

VIII. Authorized Official

Name: PASSION R WYANT
Title or Position: ADMINISTRATOR
Credential:
Phone: 660-947-2492