Provider Demographics
NPI:1043206378
Name:THE OSBY CORP.
Entity Type:Organization
Organization Name:THE OSBY CORP.
Other - Org Name:DAVIESS COUNTY NURSING & REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:TULL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-663-2197
Mailing Address - Street 1:1337 W GRAND ST
Mailing Address - Street 2:
Mailing Address - City:GALLATIN
Mailing Address - State:MO
Mailing Address - Zip Code:64640-8320
Mailing Address - Country:US
Mailing Address - Phone:660-663-2197
Mailing Address - Fax:660-663-2350
Practice Address - Street 1:1337 W GRAND ST
Practice Address - Street 2:
Practice Address - City:GALLATIN
Practice Address - State:MO
Practice Address - Zip Code:64640-8320
Practice Address - Country:US
Practice Address - Phone:660-663-2197
Practice Address - Fax:660-663-2350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-22
Last Update Date:2009-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO036776314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO101485100Medicaid
MO101485100Medicaid