Provider Demographics
NPI:1154328953
Name:HEALTH SERVICES ADMINISTRATION, INC
Entity Type:Organization
Organization Name:HEALTH SERVICES ADMINISTRATION, INC
Other - Org Name:HERITAGE HALL NURSING CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:VICE PRESIDENT - FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:REIKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-471-1113
Mailing Address - Street 1:750 E HIGHWAY 22
Mailing Address - Street 2:
Mailing Address - City:CENTRALIA
Mailing Address - State:MO
Mailing Address - Zip Code:65240-1146
Mailing Address - Country:US
Mailing Address - Phone:573-682-5551
Mailing Address - Fax:573-682-1469
Practice Address - Street 1:750 E HIGHWAY 22
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:MO
Practice Address - Zip Code:65240-1146
Practice Address - Country:US
Practice Address - Phone:573-682-5551
Practice Address - Fax:573-682-1469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO031309314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO101453900Medicaid
MO265385Medicare Oscar/Certification