Provider Demographics
NPI:1417735648
Name:THE BAPTIST HOME
Entity type:Organization
Organization Name:THE BAPTIST HOME
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-636-0400
Mailing Address - Street 1:400 E HIGH ST STE 600
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65101-3215
Mailing Address - Country:US
Mailing Address - Phone:417-237-9113
Mailing Address - Fax:
Practice Address - Street 1:601 N GALLOWAY RD
Practice Address - Street 2:
Practice Address - City:VANDALIA
Practice Address - State:MO
Practice Address - Zip Code:63382-1252
Practice Address - Country:US
Practice Address - Phone:573-594-6467
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE BAPTIST HOME
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-09-19
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility