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General NPI Number Information
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NPI Number | 1649607789
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Entity Type | Organization
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Legal Business Name | GIDEON NURSING CARE CENTER INC.
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Dates
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Enumeration Date | 10/03/2013
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Last Update Date | 11/11/2020
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Provider Practice Location Address
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Address Line | 702 N MAIN ST
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City | CLARKTON
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State | MO
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Zip | 63837-9105
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Country | US
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Telephone | 573-448-4037
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Fax | 573-448-4035
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Provider Business Mailing Address
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Address Line | 702 N MAIN ST
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City | CLARKTON
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State | MO
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Zip | 63837-9105
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Country | US
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Telephone | 573-448-4037
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Fax | 573-448-4035
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Authorized Official
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Title or Position | AGENCY DIRECTOR
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Name | TAMMY LOUGHARY
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Credential |
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Telephone | 573-448-4037
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 272662248
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License Number State | MO
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