Deaconess Long Term Care of Missouri, Inc.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

029171 Issued in MO

Legal business name

DEACONESS LONG TERM CARE OF MISSOURI, INC.

Practice address

1 Georgian Gardens Dr
Potosi, MO 63664-1436

Phone

(573) 438-6261

Fax

(573) 438-2807

NPI assigned

Aug 31, 2005

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 4

Other names 1

• Georgian Gardens Nursing Center 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": "1972597318",
    "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": "513-487-3609"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 GEORGIAN GARDENS DR",
            "city": "POTOSI",
            "state": "MO",
            "postal_code": "636641436",
            "telephone_number": "573-438-6261",
            "fax_number": "573-438-2807"
        }
    ],
    "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": "029171",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "101773901",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "128732",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7118020",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "128732",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Georgian Gardens Nursing Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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