Provider Demographics
NPI:1205865953
Name:BOONE COUNTY SENIOR CITIZEN SERVICE CORPORATION
Entity Type:Organization
Organization Name:BOONE COUNTY SENIOR CITIZEN SERVICE CORPORATION
Other - Org Name:THE BLUFFS
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:MRS
Authorized Official - First Name:ASHA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-442-6060
Mailing Address - Street 1:3105 BLUFF CREEK DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-3529
Mailing Address - Country:US
Mailing Address - Phone:573-442-6060
Mailing Address - Fax:573-874-8060
Practice Address - Street 1:3105 BLUFF CREEK DRIVE
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-3529
Practice Address - Country:US
Practice Address - Phone:573-442-6060
Practice Address - Fax:573-875-8060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO032158314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO16891503Medicaid
MO26-5498Medicare ID - Type Unspecified