Provider Demographics
NPI:1881816726
Name:MISSOURI VETERANS HOME - CAPE GIRARDEAU
Entity Type:Organization
Organization Name:MISSOURI VETERANS HOME - CAPE GIRARDEAU
Other - Org Name:CAPE GIRARDEAU VETERANS HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:VIVIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:RAINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-290-5495
Mailing Address - Street 1:2400 VETERANS MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63701-9620
Mailing Address - Country:US
Mailing Address - Phone:573-290-5870
Mailing Address - Fax:573-290-5909
Practice Address - Street 1:2400 VETERANS MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701-9620
Practice Address - Country:US
Practice Address - Phone:573-290-5870
Practice Address - Fax:573-290-5909
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MISSOURI VETERANS COMMISSION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-02
Last Update Date:2009-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility