Boonville No2 Inc

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

044927 Issued in MO

Legal business name

BOONVILLE NO2 INC

Doing business as

Riverdell Care Center

Practice address

1121 11TH St
Boonville, MO 65233-1419

Phone

(660) 882-7600

Fax

(660) 882-3473

NPI assigned

Jul 7, 2006

Last updated

Oct 26, 2021By 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

Mr. Donald B Bedell

Title

President

Phone

(573) 471-1276

Specialties & licenses 1

Addresses

Other names 1

• Riverdell Care Center Doing business as

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1740212760. Details of each certification follow.

• CCN 265361 Skilled nursing facility · Active · Details

Skilled nursing facility certification: CCN 265361

Legal name

BOONVILLE NO2 INC

Doing business as

RIVERDELL CARE CENTER

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

Mar 29, 1989

Last certification

Dec 13, 2024

Beds

60

Ownership / control type

Individual

Multi-facility organization

AVANT GUARDE HEALTH CARE

Organization structure

CorporationProprietary

Enrollment address

1121 11TH St
Boonville, MO 65233-1419

Nursing home name

RIVERDELL CARE CENTER

Affiliated entity

CIRCLE B ENTERPRISES

Listed as

Riverdell Care CenterCCN 265361 · All quality measures

Overall star rating

2 of 5

Health inspections

4 of 5

Staffing

1 of 5

Quality measures

1 of 5

Type

Medicare and Medicaid

Ownership

For profit - Individual

Certified

Mar 29, 1989

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

6048.9 residents per day on average

Chain

Circle B Enterprises36 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

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

CLIA laboratory certificates

All disclosed owners & managing parties 15

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

Owners & managing parties with NPI records 2

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

• Robert Herman Koch, M.D.

  • Family Medicine Physician
  • Boonville, MO
  • NPI 1568409142

  Adp of the SNF, Operational/Managerial Control

  CMS ownership
• Sovereign Healthcare Group, LLC

  • Home Health Agency
  • New Madrid, MO
  • NPI 1447821418

  Adp of the SNF, Operational/Managerial Control

  CMS ownership

Facilities with the same owner 41

Facilities that share an organizational owner with 5% or greater ownership or operational control.

• Ava No 1 Inc

  • Skilled Nursing Facility
  • Ava, MO
  • NPI 1518999515

  Agh1 LLC, Sovereign Healthcare Group LLC

  CMS ownership
• Boonville No 1 Inc

  dba Lakeview Health Care & Rehabilitation Center

  • Skilled Nursing Facility
  • Boonville, MO
  • NPI 1295767275

  Agh1 LLC, Circle B Enterprises Holding Company Inc, Sovereign Healthcare Group LLC

  CMS ownership
• Cameron No 1 Inc

  dba Quail Run Health Care Center

  • Skilled Nursing Facility
  • Cameron, MO
  • NPI 1194757112

  Agh1 LLC, Circle B Enterprises Holding Company Inc, Sovereign Healthcare Group LLC

  CMS ownership
• Cape Girardeau I Inc

  dba Heartland Care & Rehabilitation Center

  • Skilled Nursing Facility
  • Cape Girardeau, MO
  • NPI 1649202623

  Agh1 LLC, Circle B Enterprises Holding Company Inc, Sovereign Healthcare Group LLC

  CMS ownership
• Caruthersville No 1 Inc

  dba Southgate Living Center

  • Skilled Nursing Facility
  • Caruthersville, MO
  • NPI 1457708018

  Agh1 LLC, Sovereign Healthcare Group LLC

  CMS ownership
• Clinton No 1 Inc

  • Skilled Nursing Facility
  • Clinton, MO
  • NPI 1033141015

  Agh1 LLC, Sovereign Healthcare Group LLC

  CMS ownership
• Clinton No 2 Inc

  dba Adair Village

  • Skilled Nursing Facility
  • Clinton, MO
  • NPI 1548913288

  Agh1 LLC, Circle B Enterprises Holding Company Inc, Sovereign Healthcare Group LLC

  CMS ownership
• Collins Acres Care Center Inc

  dba Sikeston Convalescent Center

  • Skilled Nursing Facility
  • Sikeston, MO
  • NPI 1912939976

  Agh1 LLC, Circle B Enterprises Holding Company Inc, Sovereign Healthcare Group LLC

  CMS ownership
• Delhaven Manor No 2 Inc

  dba Delhaven Manor

  • Skilled Nursing Facility
  • Saint Louis, MO
  • NPI 1750313730

  Agh1 LLC, Circle B Enterprises Holding Company Inc, Sovereign Healthcare Group LLC

  CMS ownership
• Ellington 1 Inc

  dba Brent B Tinnin Manor

  • Skilled Nursing Facility
  • Ellington, MO
  • NPI 1629000690

  Agh1 LLC, Circle B Enterprises Holding Company Inc, Sovereign Healthcare Group LLC

  CMS ownership
• Excelsior Spring 1 Inc

  dba Valley Manor & Rehabilitation Center

  • Skilled Nursing Facility
  • Excelsior Springs, MO
  • NPI 1265464234

  Agh1 LLC, Circle B Enterprises Holding Company Inc, Sovereign Healthcare Group LLC

  CMS ownership
• Granby No 1 Inc

  dba Granby House

  • Skilled Nursing Facility
  • Granby, MO
  • NPI 1073545067

  Agh1 LLC, Circle B Enterprises Holding Company Inc, Sovereign Healthcare Group LLC

  CMS ownership

Practitioners 2

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.

• Robert Herman Koch, M.D.

  • Family Medicine Physician
  • Boonville, MO
  • NPI 1568409142
  NPD (past)
• Carrie M Peecher, DO

  • Family Medicine Physician
  • Marshall, MO
  • NPI 1699070052
  NPD (past)

Affiliated clinicians 1

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

• Carrie M Peecher, DO

  • Family Medicine Physician
  • Marshall, MO
  • NPI 1699070052

  Nursing home

  Care Compare affiliation

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

{
    "created_epoch": "1152230400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1635206400000",
    "number": "1740212760",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1210",
            "city": "SIKESTON",
            "state": "MO",
            "postal_code": "638011210"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1121 11TH ST",
            "city": "BOONVILLE",
            "state": "MO",
            "postal_code": "652331419",
            "telephone_number": "660-882-7600",
            "fax_number": "660-882-3473"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOONVILLE NO2 INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-07",
        "last_updated": "2021-10-26",
        "certification_date": "2021-10-26",
        "status": "A",
        "authorized_official_last_name": "BEDELL",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "573-471-1276",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MO",
            "license": "044927",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Riverdell Care Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Riverdell Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Brad Lee Boerio, R.PH.
• Shauna Lea Bohlken, APRN-CNP
• Boone Physician Services LLC (Boone Health Primary Care - Boonville)
• Boonville Chiropractic LLC
• Boonville No 1 Inc (Lakeview Health Care & Rehabilitation Center)
• Boonville Residential LLC (Hartmann Village)
• Jane Brengarth
• Bristol Care, Inc
• Mona L Brownfield, M.D.
• Ellison Brunkhorst

• Skilled Nursing Facility in Boonville, MO
• Providers in Boonville, 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 Oct 26, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.