Provider Demographics
NPI:1669457701
Name:STEELVILLE COMMUNITY SERVICES INC.
Entity Type:Organization
Organization Name:STEELVILLE COMMUNITY SERVICES INC.
Other - Org Name:GIBBS CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:G
Authorized Official - Last Name:HOWDESHELL
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:573-775-5815
Mailing Address - Street 1:311 N SPRING ST
Mailing Address - Street 2:
Mailing Address - City:STEELVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65565-5089
Mailing Address - Country:US
Mailing Address - Phone:573-775-5815
Mailing Address - Fax:573-775-4072
Practice Address - Street 1:311 N SPRING ST
Practice Address - Street 2:
Practice Address - City:STEELVILLE
Practice Address - State:MO
Practice Address - Zip Code:65565-5089
Practice Address - Country:US
Practice Address - Phone:573-775-5815
Practice Address - Fax:573-775-4072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-13
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO101486900Medicaid
MO265673Medicare Oscar/Certification