Clinton No 1 Inc
Organization Active NPI Skilled Nursing Facility · Clinton, MO
NPI 1033141015 · NPPES record last updated Mar 5, 2018
Key facts
- NPI
- 1033141015
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- License
- 046098 (MO)
- Legal business name
- CLINTON NO 1 INC
- Practice address
- 1009 E Ohio St
Clinton, MO 64735-2455 - Phone
- (660) 885-5571
- NPI assigned
- Jul 7, 2006
- Organization subpart
- No
Authorized official
- Name
- Mr. Donald B Bedell
- Title
- President
- Phone
- (573) 471-1276
Owners & managing parties with NPI records 2
-
Mark P Snell, D.O.
Facilities with the same owner 36
Practitioners 4
-
Brendan Bagley, M.D.
-
Elizabeth Logan, D.O.
-
Manik Mehra, M.D.
-
Mark P Snell, D.O.
Affiliated clinicians 5
-
Brendan Bagley, M.D.
-
Brian K Bellamy, M.D.
-
Elizabeth Logan, D.O.
-
Manik Mehra, M.D.
-
Mark P Snell, D.O.
Medicare Care Compare: Nursing home
- Listed as
- Clinton Healthcare and Rehabilitation Center
- Overall star rating
- ★☆☆☆☆ 1 of 5
- Health inspections
- ★★★☆☆ 3 of 5
- Staffing
- ★☆☆☆☆ 1 of 5
- Quality measures
- ★☆☆☆☆ 1 of 5
- Type
- Medicare and Medicaid
- Ownership
- For profit - Corporation
- Certified
- Oct 11, 1984
- Medicare certification status
- Active
- Certified beds
- 120 · 70.0 residents per day on average
- Chain
- Circle B Enterprises
- Penalties (3 years)
- 2 · fines totaling $83,041
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 26D0721193 | Clinton Healthcare & Rehabilitation Center | Certificate of waiver | Aug 31, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
Skilled nursing facility certification: CCN 265255
- Legal name
- CLINTON NO 1 INC
- Doing business as
- CLINTON HEALTHCARE AND REHABILITATION CENTER
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Oct 11, 1984
- Last certification
- Sep 5, 2024
- Beds
- 120
- Ownership / control type
- Corporation
- Multi-facility organization
- ADVANT GUARDE
- Most recent change of ownership
- May 5, 2004
- Organization structure
- Corporation · Proprietary
- Enrollment address
- 1009 E Ohio St
Clinton, MO 64735-2455 - Nursing home name
- CLINTON HEALTHCARE AND REHABILITATION CENTER
- Affiliated entity
- CIRCLE B ENTERPRISES
All disclosed owners & managing parties 15
| Name | Role | Since | Share |
|---|---|---|---|
| Sovereign Healthcare Group LLC |
Operational/Managerial Control | Apr 23, 2021 | |
| Adp of the SNF | Apr 6, 2025 | ||
| FG LLC |
Adp of the SNF | Dec 2, 2016 | |
| Mid States Inc |
Adp of the SNF | Aug 15, 2014 | |
| |
Adp of the SNF | Jan 1, 2000 | |
| Van de Ven LLC |
Adp of the SNF | Jan 1, 2000 | |
| Todd Beaird |
Corporate Officer |
Jan 1, 2022 | |
| Adp of the SNF | Jan 1, 2022 | ||
| Georgann Foster |
Operational/Managerial Control | Dec 29, 2025 | |
| Adp of the SNF | Dec 29, 2025 | ||
| Donald B Bedell |
Corporate Officer |
Apr 23, 2004 | 100% |
| Corporate Director |
Apr 23, 2004 | ||
| Operational/Managerial Control | Apr 23, 2004 | ||
| DCB Real Estate Partnership LP |
Adp of the SNF | Mar 12, 2013 | |
| Clinton Exempt Trust |
5% Or Greater Direct Ownership Interest | Apr 23, 2004 | 100% |
| Trustee of the SNF | Apr 23, 2004 | ||
| Forvis Mazars LLP |
Adp of the SNF | Aug 16, 2021 | |
| Agh1 LLC |
Operational/Managerial Control | Dec 2, 2016 | |
| Adp of the SNF | Mar 25, 2025 | ||
| Mark P Snell |
Operational/Managerial Control | Sep 1, 2001 | |
| Adp of the SNF | Sep 1, 2001 | ||
| Clinton Re LLC |
Adp of the SNF | Mar 12, 2013 | |
| |
Adp of the SNF | Jan 1, 2000 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040610001472 | MO | Part a Provider - Skilled Nursing Facility | 1658354592 | Practice locations: Clinton, MO |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 046098 | MO | Yes |
Addresses
Primary practice location
1009 E Ohio St
Clinton, MO 64735-2455
Mailing address
PO Box 1210
Sikeston, MO 63801-1210
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 101482602 | Medicaid | MO |
Other providers in Clinton, MO
- Chatterbox Speech Therapy, LLC
- Kristina L. Churchill
- Ella Clarkson
- Cami Clevenger
- Clinton Gran Villa LLC
- Clinton No 2 Inc
- Clinton Residential, LLC
- Clinton School District #124
- Andrew M Clooney
- Kristine Marie Clubb
All providers in Clinton, MO · Skilled Nursing Facility in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 5, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.