Healthcare Provider Details

I. General information

NPI: 1164404927
Provider Name (Legal Business Name): WESTPHALIA RETIREMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1899 HIGHWAY 63
WESTPHALIA MO
65085-2215
US

IV. Provider business mailing address

1899 HIGHWAY 63
WESTPHALIA MO
65085-2215
US

V. Phone/Fax

Practice location:
  • Phone: 573-455-2280
  • Fax: 573-455-2253
Mailing address:
  • Phone: 573-455-2280
  • Fax: 573-455-2253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number030609
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number030608
License Number StateMO

VIII. Authorized Official

Name: MR. TOM OTKE
Title or Position: PRESIDENT/OWNER
Credential:
Phone: 573-659-6607