Provider Demographics
NPI:1053313932
Name:MONROE COUNTY NURSING HOME DISTRICT
Entity Type:Organization
Organization Name:MONROE COUNTY NURSING HOME DISTRICT
Other - Org Name:MONROE MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARI
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:EMBREE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-327-4125
Mailing Address - Street 1:200 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:MO
Mailing Address - Zip Code:65275-1165
Mailing Address - Country:US
Mailing Address - Phone:660-327-4125
Mailing Address - Fax:660-327-5264
Practice Address - Street 1:200 SOUTH ST
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:MO
Practice Address - Zip Code:65275-1165
Practice Address - Country:US
Practice Address - Phone:660-327-4125
Practice Address - Fax:660-327-5264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-11
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO314000000X314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO101451003Medicaid
265590Medicare Oscar/Certification