Provider Demographics
NPI:1518949213
Name:GASCONADE MANOR NRSG HOME
Entity Type:Organization
Organization Name:GASCONADE MANOR NRSG HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:VOGT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-437-4101
Mailing Address - Street 1:PO BOX 520
Mailing Address - Street 2:1910 NURSING HOME RD
Mailing Address - City:OWENSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65066-0520
Mailing Address - Country:US
Mailing Address - Phone:573-437-4101
Mailing Address - Fax:573-437-3925
Practice Address - Street 1:1910 NURSING HOME ROAD
Practice Address - Street 2:
Practice Address - City:OWENSVILLE
Practice Address - State:MO
Practice Address - Zip Code:65066
Practice Address - Country:US
Practice Address - Phone:573-437-4101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility