Provider Demographics
NPI:1932130101
Name:GENERAL BAPTIST NURSING HOME, INC.
Entity Type:Organization
Organization Name:GENERAL BAPTIST NURSING HOME, INC.
Other - Org Name:GENERAL BAPTIST NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:R
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-598-1020
Mailing Address - Street 1:17108 US HIGHWAY 62
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:MO
Mailing Address - Zip Code:63933-6383
Mailing Address - Country:US
Mailing Address - Phone:573-246-2155
Mailing Address - Fax:573-246-2269
Practice Address - Street 1:17108 US HIGHWAY 62
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:MO
Practice Address - Zip Code:63933-6383
Practice Address - Country:US
Practice Address - Phone:573-246-2155
Practice Address - Fax:573-246-2269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO030762314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO101486801Medicaid
MO101486801Medicaid