Parkdale Manor Incorporated

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

015686 Issued in MO

Legal business name

PARKDALE MANOR INCORPORATED

Doing business as

Parkdale Manor Care Center

Practice address

814 W South Ave
Maryville, MO 64468-2772

Phone

(660) 582-8161

Fax

(660) 582-2798

NPI assigned

Sep 13, 2006

Last updated

Nov 23, 2016By 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

Benjamin C. Scheulen

Title

Ceo

Phone

(573) 556-6240

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Parkdale Manor Care Center Doing business as

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

{
    "created_epoch": "1158105600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1479859200000",
    "number": "1497850978",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "814 W SOUTH AVE",
            "city": "MARYVILLE",
            "state": "MO",
            "postal_code": "644682772",
            "telephone_number": "660-582-8161",
            "fax_number": "660-582-2798"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "814 W SOUTH AVE",
            "city": "MARYVILLE",
            "state": "MO",
            "postal_code": "644682772",
            "telephone_number": "660-582-8161",
            "fax_number": "660-582-2798"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARKDALE MANOR INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-13",
        "last_updated": "2016-11-23",
        "status": "A",
        "authorized_official_last_name": "SCHEULEN",
        "authorized_official_first_name": "BENJAMIN",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "573-556-6240"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MO",
            "license": "015686",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "106867104",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Parkdale Manor Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Northwest Health Services, Inc. (Maryville Elementary School Health Center)
• Northwest Missouri State University (Northwest Missouri State)
• Northwest Missouri State University (NWMSU Wellness Center)
• Kendra O'Riley
• Parkdale Manor Health & Rehabilitation LLC
• Casey R. Parman, APN
• Mark Parra
• Rebecca Ann Pearce, ARNP
• Kristen Annette Peltz, MS, LPC
• Tylan Phillip Perry, PTA

• Skilled Nursing Facility in Maryville, MO
• Providers in Maryville, 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 23, 2016; 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.