Deaconess Long Term Care of Missouri, Inc.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

029664 Issued in MO

Legal business name

DEACONESS LONG TERM CARE OF MISSOURI, INC.

Doing business as

Country Aire Retirement Estates

Practice address

18540 State Highway 16
Lewistown, MO 63452-2111

Phone

(573) 215-2216

Fax

(573) 215-2733

NPI assigned

Aug 31, 2005

Last updated

Oct 7, 2008By 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

Carla Brooks

Title

Cfo

Phone

(513) 487-3600

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Country Aire Retirement Estates Doing business as

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

{
    "created_epoch": "1125446400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1223337600000",
    "number": "1740273176",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "440 LAFAYETTE AVE",
            "address_2": "SUITE 400",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452201022",
            "telephone_number": "513-487-3600",
            "fax_number": "513-487-3653"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18540 STATE HIGHWAY 16",
            "city": "LEWISTOWN",
            "state": "MO",
            "postal_code": "634522111",
            "telephone_number": "573-215-2216",
            "fax_number": "573-215-2733"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEACONESS LONG TERM CARE OF MISSOURI, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-31",
        "last_updated": "2008-10-07",
        "status": "A",
        "authorized_official_last_name": "BROOKS",
        "authorized_official_first_name": "CARLA",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "513-487-3600"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MO",
            "license": "029664",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "5733217",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "103108304",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Country Aire Retirement Estates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Penny Elizabeth Buening, APRN
• Karen Joy Abando Cordova
• Country Aire Healthcare LLC (Country Aire Retirement Center)
• Country Aire Opco, LLC (Country Aire Retirement Center)
• Country Aire Operations Management LLC
• Michelle Ebeling, M.A., CCC-SLP
• GX2 LLC (MED-Direct)
• Tanya Lee Jones, MSW
• Lewis County Ambulance District
• Lewistown SNF Operations, LLC (Country Aire Retirement Center)

• Skilled Nursing Facility in Lewistown, MO
• Providers in Lewistown, 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 7, 2008; 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.