Provider Demographics
NPI:1114069697
Name:GIDEON NURSING CARE CENTER INC
Entity Type:Organization
Organization Name:GIDEON NURSING CARE CENTER INC
Other - Org Name:WINCHESTER COMMUNITY IN-HOME CARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DESIGNATED MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:K
Authorized Official - Last Name:LOUGHARY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-448-4037
Mailing Address - Street 1:702 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CLARKTON
Mailing Address - State:MO
Mailing Address - Zip Code:63837-9105
Mailing Address - Country:US
Mailing Address - Phone:573-448-4037
Mailing Address - Fax:573-448-4035
Practice Address - Street 1:702 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CLARKTON
Practice Address - State:MO
Practice Address - Zip Code:63837-9105
Practice Address - Country:US
Practice Address - Phone:573-448-4037
Practice Address - Fax:573-448-4035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO266224005Medicaid