Organization
POTOSI MANOR, INC.
Active
Other names
Potosi Manor
Organization subpart
No
Provider details
NPI number
Authorized official
CARLA HEDRICK CFO (CFO)
(573) 481-9625
Entity
Organization
Contact information
Practice address
307 SOUTH HIGHWAY 21, POTOSI, MO 63664-9317
(573) 438-3225
(573) 438-1230
Mailing address
307 SOUTH HIGHWAY 21, POTOSI, MO 63664-9317
(573) 438-3225
(573) 438-1230
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
031634
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
108841503
—
MO
01
—
16667131
STATE ID
MO
Enumeration date
09/22/2005
Last updated
10/02/2025
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