Healthcare Provider Details

I. General information

NPI: 1962483214
Provider Name (Legal Business Name): TRI COUNTY NURSING HOME DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2005
Last Update Date: 08/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 N GALLOWAY RD
VANDALIA MO
63382-1252
US

IV. Provider business mailing address

601 N GALLOWAY RD
VANDALIA MO
63382-1252
US

V. Phone/Fax

Practice location:
  • Phone: 573-594-6467
  • Fax: 573-594-3863
Mailing address:
  • Phone: 573-594-6467
  • Fax: 573-594-3863

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number029359
License Number StateMO

VIII. Authorized Official

Name: MRS. PENNY LOUISE KAMPETER
Title or Position: ADMINISTRATOR
Credential:
Phone: 573-594-6467