WAGNER RESIDENTIAL CARE INC (NPI# 1154673887) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1154673887 |
| Entity Type | Organization |
| Organization Name | WAGNER RESIDENTIAL CARE INC |
| Practice Address |
320 N Chamber Dr Fredericktown MO 63645-0320 |
| Practice Telephone | 5737834511 |
| Practice Fax Number | 5737834513 |
| Mailing Telephone | 5737834511 |
| Mailing Fax Number | 5737834513 |
| Enumeration Date | 2012-10-04 |
| Last Update Date | 2016-04-04 |
| Authorized Official Name | TEENA WAGNER (OWNER/MANAGER) |
| Authorized Official Telephone | 5737834511 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 310400000X | Assisted Living Facility | 040545 | MO | Nursing & Custodial Care Facilities |
| Street Address |
320 N CHAMBER DR |
| City | FREDERICKTOWN |
| State | MO |
| Zip Code | 63645-0320 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093193880 | Emily Engers | Counselor | 206 W Marvin Ave, Fredericktown, MO 63645 | 2015-05-12 |
| 1871823955 | Covenant Care Services, LLC | Custodial Care Facility | 1610 W. Hwy 72, Fredericktown, MO 63645 | 2010-01-12 |
| 1518110279 | East Missouri Action Agency, Inc. | Clinic/Center | 806 West College Rd, Fredericktown, MO 63645 | 2008-10-28 |
| 1679737324 | Linda Carole Cravens | Dentist | 731 W Main St, Guy A Walker Dds, Fredericktown, MO 63645 | 2008-07-11 |
| 1629286976 | Community Health Care Associates, Inc | Social Worker | 735 West Main, Fredericktown, MO 63645 | 2007-05-18 |
| 1467539031 | Madison Medical Center Stockhoff Memorial Nursing Home | Clinic/Center | 611 West Main Street, Fredericktown, MO 63645 | 2006-11-01 |
| 1487749537 | Covenant Care Services, LLC | Registered Nurse | 120 S. Mine Lamotte, Fredericktown, MO 63645 | 2006-10-04 |
| 1215577945 | Modern Mental Health | Community/Behavioral Health | 151 South Main Street, Suite B, Fredericktown, MO 63645 | 2020-01-10 |
| 1235392309 | Humberto Jose Olivero Lara | Family Medicine | 611 West Main Street, Fredericktown, MO 63645 | 2008-07-08 |
| 1003983859 | Madison Memorial Hospital Stockhoff Memorial Nursing Home | Pharmacy | 611 West Main Street, Fredericktown, MO 63645 | 2006-11-29 |
| Find all providers in zip 63645 | ||||
| Taxonomy Code | 310400000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Assisted Living Facility |
| A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851516546 | Ozark Manor Inc | Assisted Living Facility | 1013 Highway Z, Fredericktown, MO 63645-8035 | 2007-04-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144820283 | Oak Meadows Rcf LLC | Assisted Living Facility | 5502 Misty Meadow Rd, Poplar Bluff, MO 63901-9287 | 2020-10-28 |
| 1700486859 | Hillcrest Residential Care | Assisted Living Facility | 9415 N North Browns Station Rd, Columbia, MO 65202-8671 | 2020-10-28 |
| 1700484250 | Americare At Field Pointe LLC | Assisted Living Facility | 5002 Gene Field Road, St Joseph, MO 64506 | 2020-10-15 |
| 1205433638 | Skyline Assisted Living LLC | Assisted Living Facility | 100 Hard Rock Rd, Van Buren, MO 63965-0780 | 2020-10-08 |
| 1023615622 | Four Seasons Care Corp | Assisted Living Facility | 230 Railroad St, Moscow Mills, MO 63362-1600 | 2020-10-06 |
| 1336754985 | Tiffany Springs Senior Care Community | Assisted Living Facility | 9101 N Ambassador Dr, Kansas City, MO 64154-7295 | 2020-09-10 |
| 1366053480 | Green Acres Assisted Living LLC | Assisted Living Facility | 411 N Kings Highway, Sikeston, MO 63801-1936 | 2020-08-12 |
| 1467062612 | Welcome Home Assisted Living, LLC | Assisted Living Facility | 5 Adams Dr, Dexter, MO 63841-1985 | 2020-08-03 |
| 1831725142 | Harmony Gardens Residential, LLC | Assisted Living Facility | 539 E Young Ave, Warrensburg, MO 64093-1228 | 2020-03-18 |
| 1386278414 | Family Partners Home LLC | Assisted Living Facility | 232 Creve Coeur Ave, Manchester, MO 63011-4040 | 2020-02-27 |
| Find all providers with the same taxonomy | ||||
| City | FREDERICKTOWN |
| Zip Code | 63645 |
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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.