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NPI Code Detail

MEDICARE: DEACONESS LONG TERM CARE OF MISSOURI, INC

MEDICARE: DEACONESS LONG TERM CARE OF MISSOURI, 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
1314000000XSkilled Nursing Facility029538MO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
190399-010OTHERMOBLUE SHIELD
2262783806OTHERMOPCARE PROVIDER #
35397477OTHERMOAETNA
490399-010OTHERMOBLUE CROSS
5MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1164416509
Entity Type Code : Organization
Provider Name (Legal Business Name) : DEACONESS LONG TERM CARE OF MISSOURI, INC
Provider Business Mailing Address
First Line : 440 LAFAYETTE AVE
Second Line : SUITE 400
City : CINCINNATI
State : OH
Zip : 45220-1022
Country : US
Telephone Number : 513-487-3600
Fax Number : 513-487-3653
Provider Business Practice Location Address
First Line : 11900 JESSICA LN
Second Line :
City : RAYTOWN
State : MO
Zip : 64138-2649
Country : US
Telephone Number : 816-358-7858
Fax Number : 816-353-1514
Authorized Official
Title or Position : CFO
Name : CARLA BROOKS
Credential :
Telephone Number : 513-487-3600
Provider Enumeration Date : 08/31/2005
Last Update Date : 10/07/2008

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