Organization
JEFFERSON CITY MANOR INC
Active
Other names
Jefferson City Manor Care Center
Organization subpart
No
Provider details
NPI number
Authorized official
BENJAMIN C. SCHEULEN (CEO)
(573) 556-6240
Entity
Organization
Contact information
Practice address
1720 VIETH DR, JEFFERSON CITY, MO 65109-2056
(573) 635-6193
(573) 659-8925
Mailing address
1720 VIETH DR, JEFFERSON CITY, MO 65109-2056
(573) 635-6193
(573) 659-8925
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
017299
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102159605
—
MO
Enumeration date
09/13/2006
Last updated
11/23/2016
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