Provider Demographics
NPI:1356470637
Name:SPRING MANOR OF CARROLL COUNTY
Entity Type:Organization
Organization Name:SPRING MANOR OF CARROLL COUNTY
Other - Org Name:SPRING MANOR APARTMENTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:THURLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-542-1401
Mailing Address - Street 1:PO BOX 455
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:MO
Mailing Address - Zip Code:64633-0455
Mailing Address - Country:US
Mailing Address - Phone:660-542-1401
Mailing Address - Fax:660-542-1688
Practice Address - Street 1:212 SPRING ST
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:MO
Practice Address - Zip Code:64633-1682
Practice Address - Country:US
Practice Address - Phone:660-542-1401
Practice Address - Fax:660-542-1688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO852955517320600000X, 320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO852955517Medicaid