Provider Demographics
NPI:1720138027
Name:ST.LUKE'S MANAGEMENT ,INC.
Entity Type:Organization
Organization Name:ST.LUKE'S MANAGEMENT ,INC.
Other - Org Name:ST.LUKE'S NURSING CENTER,INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DEANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAFFER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-358-9084
Mailing Address - Street 1:1220 E FAIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:MO
Mailing Address - Zip Code:64836-3122
Mailing Address - Country:US
Mailing Address - Phone:417-358-9084
Mailing Address - Fax:417-358-6991
Practice Address - Street 1:1220 E FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:MO
Practice Address - Zip Code:64836-3122
Practice Address - Country:US
Practice Address - Phone:417-358-9084
Practice Address - Fax:417-358-6991
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST.LUKE'S NURSING CENTER,INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-11
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO031500314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO101475606Medicaid
MO265661Medicare Oscar/Certification