Provider Demographics
NPI:1982690376
Name:CURRENT RIVER NURSING CENTER, INC.
Entity Type:Organization
Organization Name:CURRENT RIVER NURSING CENTER, INC.
Other - Org Name:CURRENT RIVER NURSING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SHAREHOLDER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:C
Authorized Official - Last Name:LINCOLN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-746-7100
Mailing Address - Street 1:1015 N GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:DONIPHAN
Mailing Address - State:MO
Mailing Address - Zip Code:63935-1779
Mailing Address - Country:US
Mailing Address - Phone:573-996-4239
Mailing Address - Fax:573-996-4242
Practice Address - Street 1:1015 N GRAND AVE
Practice Address - Street 2:
Practice Address - City:DONIPHAN
Practice Address - State:MO
Practice Address - Zip Code:63935-1779
Practice Address - Country:US
Practice Address - Phone:573-996-4239
Practice Address - Fax:573-996-4242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-21
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO030141314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO14736896OtherSTATE ID
MO103206603Medicaid
MO265504Medicare Oscar/Certification