Provider Demographics
NPI:1962483214
Name:TRI COUNTY NURSING HOME DISTRICT
Entity Type:Organization
Organization Name:TRI COUNTY NURSING HOME DISTRICT
Other - Org Name:TRI COUNTY CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PENNY
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:KAMPETER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-594-6467
Mailing Address - Street 1:601 N GALLOWAY RD
Mailing Address - Street 2:
Mailing Address - City:VANDALIA
Mailing Address - State:MO
Mailing Address - Zip Code:63382-1252
Mailing Address - Country:US
Mailing Address - Phone:573-594-6467
Mailing Address - Fax:573-594-3863
Practice Address - Street 1:601 N GALLOWAY RD
Practice Address - Street 2:
Practice Address - City:VANDALIA
Practice Address - State:MO
Practice Address - Zip Code:63382-1252
Practice Address - Country:US
Practice Address - Phone:573-594-6467
Practice Address - Fax:573-594-3863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-11
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO029359314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO101477503Medicaid
MO101477503Medicaid
MO265638Medicare Oscar/Certification