Provider Demographics
NPI:1396850301
Name:MILLER COUNTY NURSING HOME DISTRICT
Entity Type:Organization
Organization Name:MILLER COUNTY NURSING HOME DISTRICT
Other - Org Name:MILLER COUNTY CARE AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:
Authorized Official - Last Name:MALMBERG
Authorized Official - Suffix:
Authorized Official - Credentials:RN C
Authorized Official - Phone:573-369-2318
Mailing Address - Street 1:1157 HIGHWAY 17
Mailing Address - Street 2:
Mailing Address - City:TUSCUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65082-2100
Mailing Address - Country:US
Mailing Address - Phone:573-369-2318
Mailing Address - Fax:573-369-3012
Practice Address - Street 1:1157 HIGHWAY 17
Practice Address - Street 2:
Practice Address - City:TUSCUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65082-2100
Practice Address - Country:US
Practice Address - Phone:573-369-2318
Practice Address - Fax:573-369-3012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO030712310400000X
MO030711314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO268240009Medicaid
MO101491603Medicaid
MO265713Medicare Oscar/Certification
MO268240009Medicaid