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General NPI Number Information
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NPI Number | 1801991104
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Entity Type | Organization
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Legal Business Name | WARRENSBURG MANOR INC
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Dates
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Enumeration Date | 09/13/2006
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Last Update Date | 08/28/2012
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Provider Practice Location Address
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Address Line | 400 CARE CENTER DR
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City | WARRENSBURG
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State | MO
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Zip | 64093-3100
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Country | US
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Telephone | 660-747-2216
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Fax | 660-747-0807
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Provider Business Mailing Address
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Address Line | 400 CARE CENTER DR
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City | WARRENSBURG
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State | MO
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Zip | 64093-3100
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Country | US
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Telephone | 660-747-2216
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Fax | 660-747-0807
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Authorized Official
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Title or Position | OWNER
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Name | MR. HAL JUCKETTE
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Credential |
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Telephone | 660-646-5385
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 016604
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License Number State | MO
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