Provider Demographics
NPI:1659309607
Name:MOKANE NO 1 INC
Entity Type:Organization
Organization Name:MOKANE NO 1 INC
Other - Org Name:RIVERVIEW NURSING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CLIFF
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIRRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-471-1276
Mailing Address - Street 1:PO BOX 1210
Mailing Address - Street 2:
Mailing Address - City:SIKESTON
Mailing Address - State:MO
Mailing Address - Zip Code:63801-1210
Mailing Address - Country:US
Mailing Address - Phone:573-471-1276
Mailing Address - Fax:
Practice Address - Street 1:10303 STATE ROAD C
Practice Address - Street 2:
Practice Address - City:MOKANE
Practice Address - State:MO
Practice Address - Zip Code:65059-1211
Practice Address - Country:US
Practice Address - Phone:573-676-3136
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-29
Last Update Date:2017-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO045671314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO101459105Medicaid
265434Medicare Oscar/Certification