NPIMap

Organization Active NPI

Citizens Memorial Health Care Foundation

Doing business as Citizens Memorial Health Care Facility

  • Skilled Nursing Facility
  • Bolivar, MO
National Provider Identifier
1932188083
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
031980 Issued in MO
Legal business name
CITIZENS MEMORIAL HEALTH CARE FOUNDATION
Doing business as
Citizens Memorial Health Care Facility
Practice address
1218 W Locust St
Bolivar, MO 65613-1312
Phone
(417) 326-7648
Fax
(417) 328-6336
NPI assigned
Jan 16, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mrs. Renee Marie Meyer
Title
Director of Finance
Phone
(417) 328-6258

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 031980 MO Primary

Addresses

Primary practice location

1218 W Locust St
Bolivar, MO 65613-1312

Mailing address

1500 N Oakland Ave
Bolivar, MO 65613-3011
Phone (417) 326-6000

Other names 1

  • Citizens Memorial Health Care Facility Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100115000908 MO Part A Provider - Skilled Nursing Facility 1658413455 Practice locations: Bolivar, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1932188083. Details of each certification follow.

Skilled nursing facility certification: CCN 265545

Legal name
CITIZENS MEMORIAL HEALTH CARE FOUNDATION
Doing business as
CITIZENS MEMORIAL HEALTH CARE FACILITY
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Sep 27, 1993
Last certification
Dec 8, 2023
Beds
111
Ownership / control type
Nonprofit Corporation
Multi-facility organization
CITIZENS MEMORIAL HEALTH CARE FOUNDATION
Organization structure
OtherNon-profit
Incorporated
Sep 24, 1986 in MO
Enrollment address
1218 W Locust St
Bolivar, MO 65613-1312
Nursing home name
CITIZENS MEMORIAL HEALTHCARE FACILITY
Affiliated entity
CITIZENS MEMORIAL HEALTH CARE

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: Nursing home

Medicare Care Compare
Listed as
Citizens Memorial Healthcare FacilityCCN 265545 · All quality measures
Overall star rating
2 of 5
Health inspections
3 of 5
Staffing
3 of 5
Quality measures
1 of 5
Type
Medicare and Medicaid
Ownership
Non profit - Corporation
Certified
Sep 27, 1993
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
11191.6 residents per day on average
Chain
Citizens Memorial Health Care6 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
26D0447108Citizens Memorial Health Care Facility1218 W Locust, Bolivar, MO 65613Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory
Tax ID family
Citizens Mem Home Medi14 organizations share this tax ID, including this one

Other organizations with this tax ID 13

Organizations that report the same tax identification number in the National Provider Directory.

View all 13

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Tim W Francka Individual W-2 Managing EmployeeAdministrative Director Aug 16, 1998
Heather Finnell Individual W-2 Managing EmployeeDirector of Finance Jan 1, 2022
Michael Calhoun Individual Corporate OfficerExecutive Director Jan 1, 2022
W-2 Managing EmployeeCeo Jan 1, 2022
Brad Johnson Individual Corporate DirectorBoard Member Jan 1, 2022
William S Donnell Individual Corporate DirectorBoard Member Mar 14, 2012
John Kallenbach Individual Corporate OfficerVice President Jan 1, 2022
Corporate DirectorBoard Member Jun 20, 2019
Janieca Lynn Hancock Individual Corporate OfficerPresident Jan 1, 2022
Corporate DirectorBoard Member Mar 15, 2018
Beverly Derrickson Individual Corporate OfficerChief Operating Officer Jan 27, 2020
Corporate Director Nov 21, 2016
W-2 Managing EmployeeChief Operating Officer Jan 27, 2020
Catherine S Molder Individual Corporate OfficerSecretary of the Board Mar 1, 2002
James Ashworth Individual Corporate DirectorBoard Member Jun 17, 2021
Renee M Meyer Individual Corporate OfficerTreasurer Jan 1, 2022
W-2 Managing EmployeeChief Financial Officer Jul 1, 1997
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

Practitioners 3

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 2

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": "1137369600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1932188083",
    "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": "656133011",
            "telephone_number": "417-326-6000",
            "fax_number": "417-328-6242"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1218 W LOCUST ST",
            "city": "BOLIVAR",
            "state": "MO",
            "postal_code": "656131312",
            "telephone_number": "417-326-7648",
            "fax_number": "417-328-6336"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CITIZENS MEMORIAL HEALTH CARE FOUNDATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-16",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MEYER",
        "authorized_official_first_name": "RENEE",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "DIRECTOR OF FINANCE",
        "authorized_official_telephone_number": "417-328-6258",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MO",
            "license": "031980",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Citizens Memorial Health Care Facility",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bolivar, MO

Sources for this page

Verify at the official NPI Registry.