Provider Demographics
NPI:1982665717
Name:GIDEON CARE CENTER, INC
Entity Type:Organization
Organization Name:GIDEON CARE CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:573-448-3505
Mailing Address - Street 1:PO BOX 197
Mailing Address - Street 2:FOURTH & LUNBECK
Mailing Address - City:GIDEON
Mailing Address - State:MO
Mailing Address - Zip Code:63848-0197
Mailing Address - Country:US
Mailing Address - Phone:573-448-3505
Mailing Address - Fax:573-448-3787
Practice Address - Street 1:300 S LUNBECK AVE
Practice Address - Street 2:
Practice Address - City:GIDEON
Practice Address - State:MO
Practice Address - Zip Code:63848-9211
Practice Address - Country:US
Practice Address - Phone:573-448-3505
Practice Address - Fax:573-448-3787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-31
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO031090314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO102757408Medicaid
MO102757408Medicaid