Deaconess Long Term Care of Missouri, Inc.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

029849 Issued in MO

Legal business name

DEACONESS LONG TERM CARE OF MISSOURI, INC.

Doing business as

Golden Years

Practice address

2001 S Jefferson Pkwy
Harrisonville, MO 64701-3714

Phone

(816) 380-4731

Fax

(816) 380-4730

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 3

Other names 1

• Golden Years 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": "1932193356",
    "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": "2001 S JEFFERSON PKWY",
            "city": "HARRISONVILLE",
            "state": "MO",
            "postal_code": "647013714",
            "telephone_number": "816-380-4731",
            "fax_number": "816-380-4730"
        }
    ],
    "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": "029849",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "90662-010",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "90662-010",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "102282704",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Golden Years",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Nicole Rae Dannen
• Donna Marie Davis, PLPC
• Kristen L Davis, PSY.D
• Deaconess Long Term Care of Missouri, Inc. (ABC Health Center)
• Deaconess Long Term Care of Missouri, Inc. (Camden Health Center)
• Lisa Deadmond, LVN
• Debi Ann Degraeve, PTA
• Devine Golden Home Healthcare Services LLC
• Devine Golden Years Home Healthcare Services LLC
• Devoe Smith Medical Foundation (Devoe Smith Free Health Clinic)

• Skilled Nursing Facility in Harrisonville, MO
• Providers in Harrisonville, 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.