Laverna Village Nursing Home Inc.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

034371 Issued in MO

Legal business name

LAVERNA VILLAGE NURSING HOME INC.

Practice address

904 Hall Avenue
Savannah, MO 64485-0279

Phone

(816) 324-3185

Fax

(816) 324-4097

NPI assigned

Oct 2, 2006

Organization subpart

Yes

Parent organization

PLATINUM HEALTH CAREAs reported in NPPES

Name

Mr. Ross P Marine

Title

Administrator

Phone

(816) 324-3185

Part of

Laverna Village Nursing Home Inc

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jul 12, 2007.

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1184198400000",
    "number": "1275626855",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 279",
            "city": "SAVANNAH",
            "state": "MO",
            "postal_code": "644850279",
            "telephone_number": "816-324-3185",
            "fax_number": "816-324-4097"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "904 HALL AVENUE",
            "city": "SAVANNAH",
            "state": "MO",
            "postal_code": "644850279",
            "telephone_number": "816-324-3185",
            "fax_number": "816-324-4097"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAVERNA VILLAGE NURSING HOME INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PLATINUM HEALTH CARE",
        "enumeration_date": "2006-10-02",
        "last_updated": "2007-07-12",
        "status": "A",
        "authorized_official_last_name": "MARINE",
        "authorized_official_first_name": "ROSS",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "816-324-3185",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MO",
            "license": "034371",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PROVIDER #",
            "identifier": "265787",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brandice J Lane
• Katherine Anne Lane, FNP
• William Jeffrey Langdon
• Laverna Manor Health & Rehabilitation LLC
• Laverna Senior Living LLC
• Kendra Michele Long, LCSW
• Kelsey McGinnis
• Shelley M. Merritt, F.N.P.
• Mosaic Medical Center - Maryville
• Polly A Nelson, O.D.

• All providers in Savannah, MO
• Skilled Nursing Facility in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.