NPIMap

Organization Active NPI

Cuba Manor, Inc.

Doing business as Cuba Manor

  • Skilled Nursing Facility
  • Cuba, MO
National Provider Identifier
1447246830
Registry record updated Sep 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
031548 Issued in MO
Legal business name
CUBA MANOR, INC.
Doing business as
Cuba Manor
Practice address
210 Eldon St
Cuba, MO 65453-1642
Phone
(573) 885-4500
Fax
(573) 885-4450
NPI assigned
Sep 21, 2005
Last updated
Sep 15, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 15, 2025

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

Authorized official

Name
Carla Hedrick, CFO
Title
Cfo
Phone
(573) 481-9625

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 031548 MO Primary

Addresses

Primary practice location

210 Eldon St
Cuba, MO 65453-1642

Mailing address

210 Eldon St
Cuba, MO 65453-1642
Phone (573) 885-4500

Other identifiers 2

IdentifierTypeStateIssuer
108297904MedicaidMO
16213459OtherMOSTATE ID

Other names 1

  • Cuba Manor Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL 199.119.81.30:8291 Other eSolutions Inc

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050922000417 MO Part A Provider - Skilled Nursing Facility 6709810427 Practice locations: Cuba, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1447246830. Details of each certification follow.

Skilled nursing facility certification: CCN 265652

Legal name
CUBA MANOR, INC.
Doing business as
CUBA MANOR
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jul 22, 1996
Last certification
Dec 11, 2024
Beds
90
Ownership / control type
Corporation
Multi-facility organization
HEALTH SYSTEMS
Organization structure
CorporationProprietary
Incorporated
Apr 1, 2002 in MO
Enrollment address
210 Eldon Drive
Cuba, MO 65453-1642
Nursing home name
CUBA MANOR INC
Affiliated entity
JAMES & JUDY LINCOLN

Care Compare: Nursing home

Medicare Care Compare
Listed as
Cuba Manor IncCCN 265652 · All quality measures
Overall star rating
4 of 5
Health inspections
4 of 5
Staffing
2 of 5
Quality measures
2 of 5
Type
Medicare and Medicaid
Ownership
For profit - Corporation
Certified
Jul 22, 1996
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
9056.6 residents per day on average
Chain
James & Judy Lincoln56 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
26D0916975Cuba Manor Inc210 Eldon Drive, Cuba, MO 65453Certificate of waiverJul 7, 2028

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Brandon Bysor Individual Corporate DirectorMember Mar 21, 2022 50%
Charlotte a Stutts Individual Corporate OfficerSecretary Oct 11, 2011 50%
Timothy O Drake Individual Corporate OfficerPresident Mar 21, 2022 50%
James Lincoln Individual General Partnership InterestMember May 21, 2002 13%
Mary Leija Individual W-2 Managing EmployeeAdministrator Mar 21, 2022 100%
Cuba Manor, Inc. Organization, Cuba, MO Corporation Operational/Managerial Control Oct 24, 2016 100%
James C Lincoln Individual 5% Or Greater Direct Ownership Interest Apr 1, 2002 50%
Judy L Lincoln Individual 5% Or Greater Direct Ownership Interest Oct 24, 2016 50%

Practitioners & affiliated clinicians

Practitioners 4

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.

Affiliated clinicians 3

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

NPI Registry JSON

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

{
    "created_epoch": "1127260800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757894400000",
    "number": "1447246830",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 ELDON ST",
            "city": "CUBA",
            "state": "MO",
            "postal_code": "654531642",
            "telephone_number": "573-885-4500",
            "fax_number": "573-885-4450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 ELDON ST",
            "city": "CUBA",
            "state": "MO",
            "postal_code": "654531642",
            "telephone_number": "573-885-4500",
            "fax_number": "573-885-4450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CUBA MANOR, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-21",
        "last_updated": "2025-09-15",
        "certification_date": "2025-09-15",
        "status": "A",
        "authorized_official_last_name": "HEDRICK",
        "authorized_official_first_name": "CARLA",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "573-481-9625",
        "authorized_official_credential": "CFO"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MO",
            "license": "031548",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "108297904",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE ID",
            "identifier": "16213459",
            "state": "MO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "199.119.81.30:8291",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.1066.1",
            "affiliationName": "eSolutions Inc",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CSV",
            "address_1": "8215 w 108th ter",
            "city": "overland park",
            "state": "KS",
            "country_code": "US",
            "postal_code": "662101661",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Cuba Manor",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cuba, MO

Sources for this page

Verify at the official NPI Registry.