Provider Demographics
NPI:1477632164
Name:CURRENT RIVER MANOR R.C.F. AND D.M.H. GROUP HOME
Entity Type:Organization
Organization Name:CURRENT RIVER MANOR R.C.F. AND D.M.H. GROUP HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:J
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-323-8828
Mailing Address - Street 1:PO BOX 447
Mailing Address - Street 2:
Mailing Address - City:VAN BUREN
Mailing Address - State:MO
Mailing Address - Zip Code:63965-0447
Mailing Address - Country:US
Mailing Address - Phone:573-323-8828
Mailing Address - Fax:573-323-4938
Practice Address - Street 1:M HWY.
Practice Address - Street 2:
Practice Address - City:VAN BUREN
Practice Address - State:MO
Practice Address - Zip Code:63965-0447
Practice Address - Country:US
Practice Address - Phone:573-323-8828
Practice Address - Fax:573-323-4938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO032108310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility