Gasconade Manor Nursing Home District
Organization Active NPI Skilled Nursing Facility · Owensville, MO
NPI 1972649705 · NPPES record last updated Sep 12, 2014
Key facts
- NPI
- 1972649705
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- License
- 031054 (MO)
- Legal business name
- GASCONADE MANOR NURSING HOME DISTRICT
- Practice address
- 1910 Nursing Home Road
Owensville, MO 65066-2844 - Phone
- (573) 437-4101
- Fax
- (573) 437-3925
- NPI assigned
- Jan 29, 2007
- Organization subpart
- No
Authorized official
- Name
- Mrs. Crystal Lynn Ray, ADMINISTRATOR
- Title
- Administrator
- Phone
- (573) 437-4101
Owners & managing parties with NPI records 1
-
Dustin Warbritton, D.O.
Corporate family (same tax ID) 1
Facilities with the same owner 3
Practitioners 1
-
Dustin Warbritton, D.O.
Affiliated clinicians 3
-
Brian R Edwards, DO
-
Elaine Hobein, FNP-C
-
Dustin Warbritton, D.O.
Medicare Care Compare: Nursing home
- Listed as
- Gasconade Manor Nursing Home
- Overall star rating
- ★★★★☆ 4 of 5
- Health inspections
- ★★★★☆ 4 of 5
- Staffing
- ★☆☆☆☆ 1 of 5
- Quality measures
- ★★★★★ 5 of 5
- Type
- Medicare and Medicaid
- Ownership
- Non profit - Other
- Certified
- Oct 1, 1993
- Medicare certification status
- Active
- Certified beds
- 79 · 59.0 residents per day on average
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
Skilled nursing facility certification: CCN 265546
- Legal name
- GASCONADE MANOR NURSING HOME DISTRICT
- Doing business as
- GASCONADE MANOR NURSING HOME
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Oct 1, 1993
- Last certification
- May 31, 2024
- Beds
- 79
- Ownership / control type
- Other Nonprofit
- Organization structure
- Government · Non-profit
- Enrollment address
- 1910 Nursing Home Road
Owensville, MO 65066-2844 - Nursing home name
- GASCONADE MANOR NURSING HOME
All disclosed owners & managing parties 13
| Name | Role | Since | Share |
|---|---|---|---|
| Lynn Hesemann |
Managing Control - Governing Body |
Jan 1, 2009 | |
| Dustin Warbritton |
Operational/Managerial Control | Jan 1, 2009 | |
| Adp of the SNF | Jan 1, 2009 | ||
| Crystal L Ray |
Operational/Managerial Control | Jul 19, 1994 | |
| Adp of the SNF | Jul 19, 1994 | ||
| Gasconade Manor Nursing Home District |
5% Or Greater Direct Ownership Interest | Oct 1, 1993 | 100% |
| Operational/Managerial Control | Oct 1, 1993 | ||
| Adp of the SNF | Oct 1, 1993 | ||
| Cynthia Bossaller |
Managing Control - Governing Body |
Feb 1, 2025 | |
| Powerback Rehabilitation LLC |
Operational/Managerial Control | Dec 1, 2014 | |
| Adp of the SNF | Apr 15, 2025 | ||
| |
Adp of the SNF | Aug 1, 2023 | |
| Roger Jett |
Managing Control - Governing Body |
Jan 1, 2016 | |
| Legends Bank |
Adp of the SNF | Aug 27, 2020 | |
| Margie Thorton |
Managing Control - Governing Body |
Jan 1, 2022 | |
| Forvis Mazars LLP |
Adp of the SNF | Nov 23, 2020 | |
| Wayne Kemper |
Managing Control - Governing Body |
Jan 1, 2025 | |
| Alexus Strothkamp |
Operational/Managerial Control | Jun 1, 2024 | |
| Adp of the SNF | Jun 1, 2024 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20091207000236 | MO | Part a Provider - Skilled Nursing Facility | 1355480237 | Practice locations: Owensville, MO |
National Provider Directory
- Tax ID family
- Gasconade Manor NH Home
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 031054 | MO | Yes |
Addresses
Primary practice location
1910 Nursing Home Road
Owensville, MO 65066-2844
Mailing address
PO Box 520
1910 Nursing Home Road
Owensville, MO 65066-0520
Phone (573) 437-4101
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 101486702 | Medicaid | MO |
Other providers in Owensville, MO
- Brian R Edwards
- Eldercare of Mid-Missouri Xiv Inc.
- Kellie Christina Elmore
- Gasconade County Board for Services for the Developmentally Disabled
- Gasconade Manor NRSG Home
- Gasconade Terrace Retirement Center
- Claire Glaser
- Emma Amalia Godat
- Marty Joseph Green
- Paige Hammer
All providers in Owensville, MO · Skilled Nursing Facility in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 12, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.