Provider Demographics
NPI:1578573077
Name:NORTH GASCONADE COUNTY HEALTHCARE INC
Entity Type:Organization
Organization Name:NORTH GASCONADE COUNTY HEALTHCARE INC
Other - Org Name:FRENE VALLEY HEALTHCARE SOUTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:LLOYD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-437-6877
Mailing Address - Street 1:PO BOX 593
Mailing Address - Street 2:1016 HWY 28 WEST
Mailing Address - City:OWENSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65066-0593
Mailing Address - Country:US
Mailing Address - Phone:573-437-6877
Mailing Address - Fax:573-437-6881
Practice Address - Street 1:1016 W HIGHWAY 28
Practice Address - Street 2:
Practice Address - City:OWENSVILLE
Practice Address - State:MO
Practice Address - Zip Code:65066-1677
Practice Address - Country:US
Practice Address - Phone:573-437-6877
Practice Address - Fax:573-437-6881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2009-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO031161314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO107797607Medicaid
265670Medicare Oscar/Certification