Provider Demographics
NPI:1306906631
Name:SCHUYLER COUNTY NURSING HOME DISTRICT
Entity type:Organization
Organization Name:SCHUYLER COUNTY NURSING HOME DISTRICT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARCIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-766-2291
Mailing Address - Street 1:1306 US HIGHWAY 63
Mailing Address - Street 2:
Mailing Address - City:QUEEN CITY
Mailing Address - State:MO
Mailing Address - Zip Code:63561-2251
Mailing Address - Country:US
Mailing Address - Phone:660-766-2291
Mailing Address - Fax:660-766-2884
Practice Address - Street 1:1306 US HIGHWAY 63
Practice Address - Street 2:
Practice Address - City:QUEEN CITY
Practice Address - State:MO
Practice Address - Zip Code:63561-2251
Practice Address - Country:US
Practice Address - Phone:660-766-2291
Practice Address - Fax:660-766-2884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO031472314000000X
MO041379314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO26E193OtherFEDERAL ID (OSCAR)
MO101495109Medicaid
MO101495109Medicaid
MO0967090001Medicare PIN