Organization
GOOD SHEPHERD CARE CENTER
Active
Parent organization
GOOD SHEPHERD NURSING HOME DISTRICT
Organization subpart
Yes
Provider details
NPI number
Legal business name
GOOD SHEPHERD NURSING HOME DISTRICT
Authorized official
MRS. REBECCA MAY MATHIOT (FINANCIAL MANAGER)
(573) 378-5411
Entity
Organization
Contact information
Practice address
1101 W CLAY RD, VERSAILLES, MO 65084-9314
(573) 378-5411
(573) 378-5415
Mailing address
1101 W CLAY RD, VERSAILLES, MO 65084-9314
(573) 378-5411
(573) 378-5415
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
—
—
261QX0100X
Occupational Medicine Clinic/Center
—
—
314000000X
Skilled Nursing Facility
Primary
031255
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101487502
—
MO
01
—
110693
BLUE CROSS OF MISSOURI
MO
01
—
124739
HEALTHLINK
MO
Enumeration date
08/04/2006
Last updated
12/06/2011
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