Provider Demographics
NPI:1982690871
Name:MOORE-PIKE NURSING HOME INC.
Entity Type:Organization
Organization Name:MOORE-PIKE NURSING HOME INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:EARLENE
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-324-5281
Mailing Address - Street 1:300 S SAINT CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:MO
Mailing Address - Zip Code:63334-2221
Mailing Address - Country:US
Mailing Address - Phone:573-324-5281
Mailing Address - Fax:573-324-6332
Practice Address - Street 1:300 S SAINT CHARLES ST
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:MO
Practice Address - Zip Code:63334-2221
Practice Address - Country:US
Practice Address - Phone:573-324-5281
Practice Address - Fax:573-324-6332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-26
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO029652314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1026666500Medicaid
MO1026666500Medicaid