Organization
DEACONESS LONG TERM CARE OF MISSOURI, INC.
Active
Other names
Country Aire Retirement Estates
Organization subpart
No
Provider details
NPI number
Authorized official
CARLA BROOKS (CFO)
(513) 487-3600
Entity
Organization
Contact information
Practice address
18540 STATE HIGHWAY 16, LEWISTOWN, MO 63452-2111
(573) 215-2216
(573) 215-2733
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
029664
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103108304
—
MO
01
—
5733217
AETNA
MO
Enumeration date
08/31/2005
Last updated
10/07/2008
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