Healthcare Provider Details

I. General information

NPI: 1801991104
Provider Name (Legal Business Name): WARRENSBURG MANOR INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 08/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 CARE CENTER DR
WARRENSBURG MO
64093-3100
US

IV. Provider business mailing address

400 CARE CENTER DR
WARRENSBURG MO
64093-3100
US

V. Phone/Fax

Practice location:
  • Phone: 660-747-2216
  • Fax: 660-747-0807
Mailing address:
  • Phone: 660-747-2216
  • Fax: 660-747-0807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number016604
License Number StateMO

VIII. Authorized Official

Name: MR. HAL JUCKETTE
Title or Position: OWNER
Credential:
Phone: 660-646-5385