Eldercare of Mid-Missouri IX, Inc.
Organization Active NPI Skilled Nursing Facility · Chillicothe, MO
NPI 1154588085 · NPPES record last updated Dec 1, 2020
Key facts
- NPI
- 1154588085
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- Legal business name
- ELDERCARE OF MID-MISSOURI IX, INC.
- Practice address
- 2601 Fair St
Chillicothe, MO 64601-3525 - Phone
- (660) 646-1230
- NPI assigned
- May 19, 2008
- Organization subpart
- No
Authorized official
- Name
- Mark Lierman
- Title
- Authorized Official
- Phone
- (636) 477-3280
Owners & managing parties with NPI records 1
-
Richard Lee Smith, M.D.
Facilities with the same owner 11
Practitioners 2
-
Richard Lee Smith, M.D.
Affiliated clinicians 2
-
Richard Lee Smith, M.D.
Medicare Care Compare: Nursing home
- Listed as
- Stonebridge Chillicothe
- Overall star rating
- ★★★★★ 5 of 5
- Health inspections
- ★★★★★ 5 of 5
- Staffing
- ★★★☆☆ 3 of 5
- Quality measures
- ★★★★☆ 4 of 5
- Type
- Medicare and Medicaid
- Ownership
- For profit - Corporation
- Certified
- Apr 23, 2004
- Medicare certification status
- Active
- Certified beds
- 75 · 56.2 residents per day on average
- Chain
- Stonebridge Senior Living
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
Skilled nursing facility certification: CCN 265785
- Legal name
- ELDERCARE OF MID-MISSOURI IX INC
- Doing business as
- STONEBRIDGE CHILLICOTHE
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Apr 23, 2004
- Last certification
- Jan 10, 2025
- Beds
- 75
- Ownership / control type
- Corporation
- Multi-facility organization
- ELDERCARE MANAGEMENT
- Most recent change of ownership
- May 1, 2008
- Organization structure
- Corporation · Proprietary
- Enrollment address
- 2601 Fair St
Chillicothe, MO 64601-3525 - Nursing home name
- STONEBRIDGE CHILLICOTHE
- Affiliated entity
- STONEBRIDGE SENIOR LIVING
All disclosed owners & managing parties 14
| Name | Role | Since | Share |
|---|---|---|---|
| Beth Miller |
Corporate Officer |
Jan 17, 2023 | |
| Eric Doerhoff |
Operational/Managerial Control |
Nov 1, 2021 | 50% |
| Adp of the SNF | Nov 1, 2021 | ||
| Eldercare Management Services Inc |
Operational/Managerial Control | Mar 12, 2008 | |
| Adp of the SNF | Apr 22, 2025 | ||
| Jeanne Thayer |
Operational/Managerial Control | Nov 1, 2021 | |
| Adp of the SNF | Nov 1, 2021 | ||
| |
Adp of the SNF | Jan 3, 2022 | |
| Wipfli LLP |
Adp of the SNF | Jan 1, 2025 | |
| Bridge Rehabilitation Inc |
Operational/Managerial Control | Feb 1, 2024 | |
| Adp of the SNF | Apr 22, 2025 | ||
| Mark W Lierman |
5% Or Greater Direct Ownership Interest |
Nov 1, 2021 | 100% |
| Corporate Officer |
Nov 1, 2021 | 100% | |
| Operational/Managerial Control | Nov 1, 2021 | ||
| Adp of the SNF | Nov 1, 2021 | ||
| Jamie West |
Operational/Managerial Control | Mar 1, 2019 | |
| Adp of the SNF | Mar 1, 2019 | ||
| Lierman Family Co IX, LLC |
Adp of the SNF | May 1, 2008 | |
| Forvis Mazars LLP |
Adp of the SNF | Jan 25, 2016 | |
| Busey Corporation |
Operational/Managerial Control | Sep 10, 2023 | |
| Richard L Smith |
Operational/Managerial Control | May 15, 2023 | |
| Adp of the SNF | May 15, 2023 | ||
| |
Adp of the SNF | Feb 1, 2023 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080812000610 | MO | Part a Provider - Skilled Nursing Facility | 0941375885 | Practice locations: Chillicothe, MO |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | Yes |
Addresses
Primary practice location
2601 Fair St
Chillicothe, MO 64601-3525
Mailing address
2601 Fair St
Chillicothe, MO 64601-3525
Phone (636) 477-3280
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 101488005 | Medicaid | MO |
Other names
- StoneBridge Chillicothe
NPI Registry JSON
{
"created_epoch": "1211155200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1606780800000",
"number": "1154588085",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2601 FAIR ST",
"city": "CHILLICOTHE",
"state": "MO",
"postal_code": "646013525",
"telephone_number": "636-477-3280"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2601 FAIR ST",
"city": "CHILLICOTHE",
"state": "MO",
"postal_code": "646013525",
"telephone_number": "660-646-1230"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "ELDERCARE OF MID-MISSOURI IX, INC.",
"organizational_subpart": "NO",
"enumeration_date": "2008-05-19",
"last_updated": "2020-12-01",
"certification_date": "2020-12-01",
"status": "A",
"authorized_official_last_name": "LIERMAN",
"authorized_official_first_name": "MARK",
"authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
"authorized_official_telephone_number": "636-477-3280"
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "101488005",
"state": "MO"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "StoneBridge Chillicothe",
"code": "3",
"type": "Doing Business As"
}
]
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 1, 2020. 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.