Organization
CITIZENS MEMORIAL HEALTH CARE FOUNDATION
Active
Other names
Lake Stockton Healthcare Facility
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KEVIN COSTELLO (ADMINISTRATOR)
(417) 276-5126
Entity
Organization
Contact information
Practice address
811 OWENS MILL RD, STOCKTON, MO 65785
(417) 276-5126
(417) 276-8376
Mailing address
PO BOX 945, STOCKTON, MO 65785-0945
(417) 276-5126
(417) 276-8376
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
039681
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101496305
—
MO
Enumeration date
01/19/2006
Last updated
12/11/2011
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