Provider Demographics
NPI:1316148026
Name:JONES WILDWOOD CARE CENTER
Entity type:Organization
Organization Name:JONES WILDWOOD CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:L
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:660-291-8636
Mailing Address - Street 1:12806 HIGHWAY 151
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MO
Mailing Address - Zip Code:65263-3114
Mailing Address - Country:US
Mailing Address - Phone:660-291-8636
Mailing Address - Fax:660-291-8631
Practice Address - Street 1:12806 HIGHWAY 151
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MO
Practice Address - Zip Code:65263-3114
Practice Address - Country:US
Practice Address - Phone:660-291-8636
Practice Address - Fax:660-291-8631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO032074313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility