Provider Demographics
NPI:1922080886
Name:CLOSE TO HOME, INC.
Entity Type:Organization
Organization Name:CLOSE TO HOME, INC.
Other - Org Name:SELLS REST HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT, CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:SELLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-471-5800
Mailing Address - Street 1:258 N KINGSHIGHWAY ST
Mailing Address - Street 2:
Mailing Address - City:SIKESTON
Mailing Address - State:MO
Mailing Address - Zip Code:63801-4102
Mailing Address - Country:US
Mailing Address - Phone:573-471-5800
Mailing Address - Fax:573-471-6649
Practice Address - Street 1:609 S RAILROAD
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:MO
Practice Address - Zip Code:63867-9751
Practice Address - Country:US
Practice Address - Phone:573-471-7861
Practice Address - Fax:573-471-9527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO031384314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO265774Medicare Oscar/Certification