=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194649830
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SCOTLAND COUNTY NURSING HOME DISTRICT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/06/2026
-----------------------------------------------------
Last Update Date | 08/06/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 434 E SIGLER AVE
-----------------------------------------------------
City | MEMPHIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63555-1714
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 660-465-7221
-----------------------------------------------------
Fax | 660-465-7224
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 434 E SIGLER AVE
-----------------------------------------------------
City | MEMPHIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63555-1714
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 660-465-7221
-----------------------------------------------------
Fax | 660-465-7224
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MRS. STEPHANIE GRACE KETCHUM
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 660-465-7221
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 313M00000X
-----------------------------------------------------
Taxonomy Name | Nursing Facility/Intermediate Care Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------