Organization
DEACONESS LONG TERM CARE OF MISSOURI, INC.
Active
Other names
ABC Health Center
Organization subpart
No
Provider details
NPI number
Authorized official
CARLA BROOKS (CFO)
(513) 487-3600
Entity
Organization
Contact information
Practice address
307 E SOUTH ST, HARRISONVILLE, MO 64701-3241
(816) 380-7399
(816) 380-6352
Mailing address
440 LAFAYETTE AVE, SUITE 400, CINCINNATI, OH 45220-1022
(513) 487-3600
(513) 487-3653
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
029252
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101472900
—
MO
01
—
4652284
AETNA
MO
01
—
90447-013
BLUE CROSS BLUE SHIELD
MO
Enumeration date
08/31/2005
Last updated
10/07/2008
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