MEDICARE: MONROE CITY MANOR CARE CENTER, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	031459	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023001799
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MONROE CITY MANOR CARE CENTER, INC

Provider Business Mailing Address
First Line	:	1010 HWY 24 & 36 E
Second Line	:
City	:	MONROE CITY
State	:	MO
Zip	:	63456
Country	:	US
Telephone Number	:	573-735-4850
Fax Number	:	573-735-3511

Provider Business Practice Location Address
First Line	:	1010 HIGHWAY 24 AND 36 E
Second Line	:
City	:	MONROE CITY
State	:	MO
Zip	:	63456-1116
Country	:	US
Telephone Number	:	573-735-4850
Fax Number	:	573-735-3511

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. ALEXANDRA L EDRIS
Credential	:
Telephone Number	:	573-735-4850

Provider Enumeration Date	:	08/26/2005
Last Update Date	:	08/23/2016

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