Golden Age Nursing Home District

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

038984 Issued in MO

Legal business name

GOLDEN AGE NURSING HOME DISTRICT

Practice address

12498 SE Highway 116
Braymer, MO 64624-9107

Phone

(660) 645-2243

Fax

(660) 645-2719

NPI assigned

Oct 6, 2005

Last updated

Nov 21, 2011By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Tammy J Murdock, LPN

Title

Administrator

Phone

(660) 645-2243

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1043208796. Details of each certification follow.

• CCN 265718 Skilled nursing facility · Active · Details

Skilled nursing facility certification: CCN 265718

Legal name

GOLDEN AGE NURSING HOME DISTRICT

Doing business as

GOLDEN AGE NURSING HOME

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

May 23, 2001

Last certification

Sep 3, 2024

Beds

83

Ownership / control type

County

Organization structure

GovernmentNon-profit

Enrollment address

12498 SE Hwy 116
Braymer, MO 64624-9107

Nursing home name

GOLDEN AGE NURSING HOME

Listed as

Golden Age Nursing HomeCCN 265718 · All quality measures

Overall star rating

4 of 5

Health inspections

4 of 5

Staffing

4 of 5

Quality measures

2 of 5

Type

Medicare and Medicaid

Ownership

Government - County

Certified

May 23, 2001

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

8336.1 residents per day on average

Penalties (3 years)

1Fines totaling $0

Processed by Care Compare on Aug 1, 2026.

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

All disclosed owners & managing parties 11

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

• James W Neely, DO

  • Family Medicine Physician
  • Cameron, MO
  • NPI 1962486951

  Adp of the SNF, Operational/Managerial Control

  CMS ownership
• Gerald W Clevenger, PAC

  • Physician Assistant
  • Troy, KS
  • NPI 1083610646

  Operational/Managerial Control

  CMS ownership

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• James W Neely, DO

  • Family Medicine Physician
  • Cameron, MO
  • NPI 1962486951
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1128556800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1321833600000",
    "number": "1043208796",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12498 SE HIGHWAY 116",
            "city": "BRAYMER",
            "state": "MO",
            "postal_code": "646249107",
            "telephone_number": "660-645-2243",
            "fax_number": "660-645-2719"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12498 SE HIGHWAY 116",
            "city": "BRAYMER",
            "state": "MO",
            "postal_code": "646249107",
            "telephone_number": "660-645-2243",
            "fax_number": "660-645-2719"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOLDEN AGE NURSING HOME DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-06",
        "last_updated": "2011-11-21",
        "status": "A",
        "authorized_official_last_name": "MURDOCK",
        "authorized_official_first_name": "TAMMY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "660-645-2243",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LPN"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MO",
            "license": "038984",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "101487106",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Braymer C-4 School
• Harlie Mayson Crowe
• Sarah Ann Findley, FNP
• Cailyn Ranae Haley, BSN, RN IBCLC
• Dorothy Milburn, FNP
• Northwest Health Services Inc (Braymer Clinic)
• Daniel Scott Pennington, D.C.
• Hillary Marie Simpson, DPT

• Skilled Nursing Facility in Braymer, MO
• Providers in Braymer, MO by specialty
• Skilled Nursing Facility in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.