Provider Demographics
NPI:1457385783
Name:SENIOR CITIZENS NURSING HOME DISTRICT OF RAY COUNTY
Entity Type:Organization
Organization Name:SENIOR CITIZENS NURSING HOME DISTRICT OF RAY COUNTY
Other - Org Name:SHIRKEY NURSING AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:S
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-776-5403
Mailing Address - Street 1:804 WOLLARD BLVD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:MO
Mailing Address - Zip Code:64085-2227
Mailing Address - Country:US
Mailing Address - Phone:816-776-5403
Mailing Address - Fax:816-776-3591
Practice Address - Street 1:804 WOLLARD BLVD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:MO
Practice Address - Zip Code:64085-2227
Practice Address - Country:US
Practice Address - Phone:816-776-5403
Practice Address - Fax:816-776-3591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO031544314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO265708Medicare Oscar/Certification