Provider Demographics
NPI:1316937642
Name:KNOX COUNTY NURSING HOME DISTRICT
Entity type:Organization
Organization Name:KNOX COUNTY NURSING HOME DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHRAGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-397-2282
Mailing Address - Street 1:55774 STATE HIGHWAY 6
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MO
Mailing Address - Zip Code:63537-4253
Mailing Address - Country:US
Mailing Address - Phone:660-397-2282
Mailing Address - Fax:660-397-2284
Practice Address - Street 1:55774 STATE HIGHWAY 6
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MO
Practice Address - Zip Code:63537-4253
Practice Address - Country:US
Practice Address - Phone:660-397-2282
Practice Address - Fax:660-397-2284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-27
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO031485314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO101488906Medicaid
MO101488906Medicaid