CITIZENS MEMORIAL HEALTH CARE FOUNDATION (NPI# 1134109713) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1134109713 |
| Entity Type | Organization |
| Organization Name | CITIZENS MEMORIAL HEALTH CARE FOUNDATION |
| Other Organization Name | LAKE STOCKTON HEALTHCARE FACILITY |
| Practice Address |
811 Owens Mill Rd Stockton MO 65785 |
| Mailing Address |
Po Box 945 Stockton MO 65785-0945 |
| Practice Telephone | 4172765126 |
| Practice Fax Number | 4172768376 |
| Mailing Telephone | 4172765126 |
| Mailing Fax Number | 4172768376 |
| Enumeration Date | 2006-01-19 |
| Last Update Date | 2011-12-11 |
| Authorized Official Name | MR. KEVIN COSTELLO (ADMINISTRATOR) |
| Authorized Official Telephone | 4172765126 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 314000000X | Skilled Nursing Facility | 039681 | MO | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MO | 101496305 | 05 |
| Other Name | Type Code |
|---|---|
| Lake Stockton Healthcare Facility | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659646255 | Citizens Memorial Health Care Foundation | Durable Medical Equipment & Medical Supplies | 121 W Main, Warsaw, MO 65355-3195 | 2012-03-14 |
| 1568737161 | Citizens Memorial Health Care Foundation | Durable Medical Equipment & Medical Supplies | 1521 S 3rd Street, Stockton, MO 65785-9608 | 2012-03-14 |
| 1003181777 | Citizens Memorial Health Care Foundation | Durable Medical Equipment & Medical Supplies | 105 N Grand St Ste 3, Greenfield, MO 65661-8198 | 2012-03-14 |
| 1902171705 | Citizens Memorial Health Care Foundation | Durable Medical Equipment & Medical Supplies | 114 W Polk St, Hermitage, MO 65668-0382 | 2012-03-13 |
| 1639384597 | Citizens Memorial Health Care Foundation | Clinic/Center | 1500 N. Oakland Ave, Bolivar, MO 65613-3099 | 2007-05-14 |
| 1689791311 | Citizens Memorial Health Care Foundation | Assisted Living Facility | 1120 N Butterfield Rd, Bolivar, MO 65613-1000 | 2007-03-26 |
| 1124157169 | Citizens Memorial Health Care Foundation | Hospice Care, Community Based | 111 W Broadway St, Bolivar, MO 65613-1501 | 2007-03-05 |
| 1205807898 | Citizens Memorial Health Care Foundation | Durable Medical Equipment & Medical Supplies | 309 S Ash St, Suite 101, Buffalo, MO 65622-8300 | 2006-01-31 |
| 1255302451 | Citizens Memorial Health Care Foundation | Pharmacy | 1301b N Oakland Ave, Bolivar, MO 65613-3019 | 2006-01-27 |
| 1285605477 | Citizens Memorial Health Care Foundation | Durable Medical Equipment & Medical Supplies | 1915 S Springfield Ave, Bolivar, MO 65613-9684 | 2006-01-27 |
| Street Address |
811 OWENS MILL RD |
| City | STOCKTON |
| State | MO |
| Zip Code | 65785 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891017356 | Debbie Lynn Haines | Pharmacy Technician | 19 Public Square, Stockton, MO 65785 | 2010-02-24 |
| 1316003759 | Cheryl Thornton | Psychologist | 808 South St, Stockton, MO 65785 | 2006-12-29 |
| 1336192582 | Rodger S Campbell | Emergency Medicine | 106 West Blair Drive, Stockton, MO 65785 | 2006-05-18 |
| 1376865865 | Katherine Marie Hicks | Pharmacy Technician | 19 Public Square, Stockton, MO 65785 | 2010-02-24 |
| 1639212608 | Stockton R-i School District | Physical Therapist | 906 South St, Stockton, MO 65785 | 2007-02-15 |
| 1114249752 | Karen Sue Purtle | Pharmacist | 19 Public Square, Stockton, MO 65785-0189 | 2010-02-24 |
| 1801921366 | Emily F Green | Speech-Language Pathologist | 906 Sout St, Stockton R-i School District, Stockton, MO 65785-0190 | 2007-02-23 |
| 1942223649 | Troy Devon Evans | Chiropractor | 107 W Hwy 32, Suite D, Stockton, MO 65785-0384 | 2006-07-25 |
| 1962683524 | Craig Maxwell, D.d.s., P.C. | Dentist | 201 West Smith Drive, Stockton, MO 65785-0609 | 2007-11-23 |
| 1609885524 | Neale Wayne Johnson | Dentist | 201 W. Smith Dr., Stockton, MO 65785-0609 | 2006-08-07 |
| Find all providers in zip 65785 | ||||
| Taxonomy Code | 314000000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Skilled Nursing Facility |
| (1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis. |
| Notes: Source: (1) "Glossary of terms used in managed care" Developed by the Managed Care Assembly (MCA) of Medical Group Management Association (MGMA), MGM Journal, September/October 1995, p. 64; (2) AHA Guide, 1996 Annual Survey. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316330152 | Waverly Place of Stockton, LLC | Skilled Nursing Facility | 501 E Front Avenue, Stockton, IL 61085 | 2015-03-17 |
| 1932507431 | Sandra Rae Divine | Skilled Nursing Facility | 1015 Lancaster Dr, Stockton, MO 65785-8360 | 2014-12-15 |
| 1114323136 | Good Samaritan Care Provider LLC | Skilled Nursing Facility | 10740 Oakwilde Ave, Stockton, CA 95212-9249 | 2014-11-19 |
| 1801938816 | Covenant Care California, LLC | Skilled Nursing Facility | 9289 Branstetter Place, Stockton, CA 95209-1700 | 2007-02-13 |
| 1730269184 | O'connor Woods Housing Corp | Skilled Nursing Facility | 3110 Wagner Heights Rd, Stockton, CA 95209-4848 | 2006-10-17 |
| 1891700464 | Kindred Nursing Centers West, LLC | Skilled Nursing Facility | 1517 E Knickerbocker Dr, Stockton, CA 95210-3119 | 2006-07-30 |
| 1548283542 | Stockton Edison Healthcare Corporation | Skilled Nursing Facility | 1630 N. Edison St., Stockton, CA 95204 | 2006-07-25 |
| 1871512046 | Helios Healthcare, LLC | Skilled Nursing Facility | 442 E Hampton St, Stockton, CA 95204-5519 | 2006-07-19 |
| 1922027002 | Helios Healthcare, LLC | Skilled Nursing Facility | 6940 Pacific Ave, Stockton, CA 95207-2602 | 2006-07-19 |
| 1487601704 | Sunbridge Stockton Rehabilitation Center LLC | Skilled Nursing Facility | 9107 Davis Rd, Stockton, CA 95209-1807 | 2006-05-30 |
| Find all providers in STOCKTON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.