Provider Demographics
NPI:1750431052
Name:ST LUKES CARE CENTER, INC
Entity type:Organization
Organization Name:ST LUKES CARE CENTER, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SUE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOSLEN
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?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO031499310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility