Provider Demographics
NPI:1417946187
Name:THE SCOTT COUNTY REST HOME, INC.
Entity Type:Organization
Organization Name:THE SCOTT COUNTY REST HOME, INC.
Other - Org Name:PARK LANE NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR/EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:S
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:LACHA (PROVISIONAL)
Authorized Official - Phone:620-872-5871
Mailing Address - Street 1:210 E PARK LN
Mailing Address - Street 2:
Mailing Address - City:SCOTT CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67871-1960
Mailing Address - Country:US
Mailing Address - Phone:620-872-5871
Mailing Address - Fax:620-872-2128
Practice Address - Street 1:210 E PARK LN
Practice Address - Street 2:
Practice Address - City:SCOTT CITY
Practice Address - State:KS
Practice Address - Zip Code:67871-1960
Practice Address - Country:US
Practice Address - Phone:620-872-5871
Practice Address - Fax:620-872-2128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-17
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSN086001313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility