NPIMap

Organization Active NPI

Citizens Memorial Health Care Foundation

Doing business as Citizens Memorial Home Health

  • Home Health Agency
  • Bolivar, MO
National Provider Identifier
1376672238
Registry record updated Feb 18, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
2-22 Issued in MO
Legal business name
CITIZENS MEMORIAL HEALTH CARE FOUNDATION
Doing business as
Citizens Memorial Home Health
Practice address
111 W Broadway St
Bolivar, MO 65613-1501
Phone
(417) 328-6350
Fax
(417) 328-6987
NPI assigned
Mar 5, 2007
Last updated
Feb 18, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 18, 2020

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

Authorized official

Name
Gary D. Fulbright
Title
Executive Director
Phone
(417) 328-6501

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X NU
Home Health Agency 251E00000X 2-22 MO Primary

Addresses

Primary practice location

111 W Broadway St
Bolivar, MO 65613-1501

Mailing address

1500 N Oakland Ave
Bolivar, MO 65613-3099
Phone (417) 326-6000

Other names 1

  • Citizens Memorial Home Health Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20181221001228 MO Part A Provider - Home Health Agency 1658413455 Practice locations: Bolivar, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1376672238. Details of each certification follow.

Home health agency certification: CCN 267196

Legal name
CITIZENS MEMORIAL HEALTH CARE FOUNDATION
Doing business as
CITIZENS MEMORIAL HOME HEALTH
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Mar 5, 1984
Last certification
Jan 25, 2021
Ownership / control type
Proprietary
Organization structure
CorporationNon-profit
Incorporated
Sep 24, 1986 in MO
Enrollment address
111 W Broadway St
Bolivar, MO 65613-1501

Other NPIs with the same Medicare PAC ID 10

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Home health agency

Medicare Care Compare
Listed as
Citizens Memorial Home HealthCCN 267196 · All quality measures
Overall star rating
2.5 of 5
Ownership
Proprietary
Certified
Mar 5, 1984
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Michael Calhoun Individual Corporate OfficerExecutive Director Jan 1, 2022
W-2 Managing EmployeeCeo Jan 1, 2022
Gary D Fulbright Individual Corporate DirectorBoard Member Jan 30, 2022
John Kallenbach Individual Corporate OfficerVice President Dec 31, 2021
Corporate Director Jun 20, 2019
Kenneth R Smith Individual Corporate DirectorBoard Member Jan 30, 2020
Janieca Lynn Hancock Individual Corporate OfficerPresident Dec 31, 2021
Corporate Director Mar 15, 2018
James Ashworth Individual Corporate Director Jun 17, 2021
Renee M Meyer Individual Corporate OfficerTreasurer Jan 1, 2022
W-2 Managing EmployeeChief Financial Officer Feb 1, 2020
Katrina S Banner Individual Corporate DirectorBoard Member Jan 30, 2022
Donald J Babb Individual Corporate DirectorBoard Member Dec 19, 2019
Dana M Meents Individual Corporate DirectorBoard Member Oct 14, 2010

Owners & managing parties with NPI records 2

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

Practitioners & affiliated clinicians

Affiliated clinicians 25

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 25

NPI Registry JSON

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

{
    "created_epoch": "1173052800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1581984000000",
    "number": "1376672238",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 N OAKLAND AVE",
            "city": "BOLIVAR",
            "state": "MO",
            "postal_code": "656133099",
            "telephone_number": "417-326-6000",
            "fax_number": "417-328-6237"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 W BROADWAY ST",
            "city": "BOLIVAR",
            "state": "MO",
            "postal_code": "656131501",
            "telephone_number": "417-328-6350",
            "fax_number": "417-328-6987"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CITIZENS MEMORIAL HEALTH CARE FOUNDATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-05",
        "last_updated": "2020-02-18",
        "certification_date": "2020-02-18",
        "status": "A",
        "authorized_official_last_name": "FULBRIGHT",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "417-328-6501"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "MO",
            "license": "2-22",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Citizens Memorial Home Health",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Citizens Memorial Home Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bolivar, MO

Sources for this page

Verify at the official NPI Registry.