Provider Demographics
NPI:1659363224
Name:CLINTON CONVALESCENT CENTER, INC.
Entity Type:Organization
Organization Name:CLINTON CONVALESCENT CENTER, INC.
Other - Org Name:OAKRIDGE OF PLATTSBURG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-539-2128
Mailing Address - Street 1:PO BOX 247
Mailing Address - Street 2:205 E. CLAY AVE.
Mailing Address - City:PLATTSBURG
Mailing Address - State:MO
Mailing Address - Zip Code:64477-0247
Mailing Address - Country:US
Mailing Address - Phone:816-539-2128
Mailing Address - Fax:816-539-2715
Practice Address - Street 1:205 E CLAY AVE
Practice Address - Street 2:
Practice Address - City:PLATTSBURG
Practice Address - State:MO
Practice Address - Zip Code:64477-8100
Practice Address - Country:US
Practice Address - Phone:816-539-2128
Practice Address - Fax:816-539-2715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-18
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO030633314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO102684800Medicaid
MO102684800Medicaid