Provider Demographics
NPI:1417795758
Name:THE BAPTIST HOME
Entity type:Organization
Organization Name:THE BAPTIST HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:TROY
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:CULBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-556-0338
Mailing Address - Street 1:PO BOX 390
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65102-0397
Mailing Address - Country:US
Mailing Address - Phone:573-556-0338
Mailing Address - Fax:
Practice Address - Street 1:5751 BAPTIST HOME AVE
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:MO
Practice Address - Zip Code:65010-9570
Practice Address - Country:US
Practice Address - Phone:573-657-0506
Practice Address - Fax:573-657-3017
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE BAPTIST HOME
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-07-19
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility