Provider Demographics
NPI:1336232412
Name:CHRISTIAN HEALTH CARE OF REPUBLIC, INC.
Entity Type:Organization
Organization Name:CHRISTIAN HEALTH CARE OF REPUBLIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:STAYTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-891-9939
Mailing Address - Street 1:901 E HIGHWAY 174
Mailing Address - Street 2:
Mailing Address - City:REPUBLIC
Mailing Address - State:MO
Mailing Address - Zip Code:65738-1155
Mailing Address - Country:US
Mailing Address - Phone:417-732-1822
Mailing Address - Fax:417-732-1084
Practice Address - Street 1:901 E STATE HIGHWAY 174
Practice Address - Street 2:
Practice Address - City:REPUBLIC
Practice Address - State:MO
Practice Address - Zip Code:65738-1155
Practice Address - Country:US
Practice Address - Phone:417-732-1822
Practice Address - Fax:417-732-1084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO032076314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO102459104Medicaid
MO102459104Medicaid
265326Medicare Oscar/Certification