JEFFERSON CITY MANOR INC (NPI# 1962507459) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1962507459 |
| Entity Type | Organization |
| Organization Name | JEFFERSON CITY MANOR INC |
| Other Organization Name | JEFFERSON CITY MANOR CARE CENTER |
| Practice Address |
1720 Vieth Dr Jefferson City MO 65109-2056 |
| Practice Telephone | 5736356193 |
| Practice Fax Number | 5736598925 |
| Mailing Telephone | 5736356193 |
| Mailing Fax Number | 5736598925 |
| Enumeration Date | 2006-09-13 |
| Last Update Date | 2016-11-23 |
| Authorized Official Name | BENJAMIN C. SCHEULEN (CEO) |
| Authorized Official Telephone | 5735566240 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 314000000X | Skilled Nursing Facility | 017299 | MO | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MO | 102159605 | 05 |
| Other Name | Type Code |
|---|---|
| Jefferson City Manor Care Center | Doing Business As Name - Organization |
| Street Address |
1720 VIETH DR |
| City | JEFFERSON CITY |
| State | MO |
| Zip Code | 65109-2056 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376549592 | Pamala S Swartz | Nurse Practitioner | 1720 Vieth Dr, Jefferson City, MO 65109-2056 | 2005-06-22 |
| 1154957579 | Justin Lauf | Occupational Therapist | 1720 Vieth Dr, Jefferson City, MO 65109-2056 | 2020-03-17 |
| 1457982811 | Elizabeth Christine Costello | Occupational Therapy Assistant | 1720 Vieth Dr, Jefferson City, MO 65109-2056 | 2020-02-03 |
| 1366072688 | Jeffery Orr | Physical Therapist | 1720 Vieth Dr, Jefferson City, MO 65109-2056 | 2020-01-26 |
| 1578035051 | Mariah R Zahnter | Physical Therapy Assistant | 1720 Vieth Dr, Jefferson City, MO 65109-2056 | 2018-12-21 |
| 1275004210 | Nicole Brook Roach | Physical Therapy Assistant | 1720 Vieth Dr, Jefferson City, MO 65109-2056 | 2018-12-17 |
| 1215409198 | Jill Dennis | Physical Therapy Assistant | 1720 Vieth Dr, Jefferson City, MO 65109-2056 | 2018-12-17 |
| 1346719176 | Cali Inez Boessen | Physical Therapy Assistant | 1720 Vieth Dr, Jefferson City, MO 65109-2056 | 2018-11-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518449321 | Kara D Roderick | Physical Therapist | 1115 Fairgrounds Road, Jefferson City, MO 65109 | 2018-08-29 |
| 1851871214 | Integrative Medicine, LLC | Internal Medicine | 999 Diamond Rdg Ste 201, Jefferson City, MO 65109 | 2018-08-15 |
| 1972020394 | Rehab Care Group East, LLC | Clinic/Center | Primrose Retirement Community Jefferson City, 1214 Freedom Boulevard, Jefferson City, MO 65109 | 2017-08-25 |
| 1124558986 | Nicholas Rehagen | Specialist/Technologist | 304 Timber Creek Rd, Jefferson City, MO 65109 | 2017-06-14 |
| 1982004214 | Kara Elizabeth Wilbers | Occupational Therapist | 1105 Fairgrounds Rd, Jefferson City, MO 65109 | 2014-08-22 |
| 1942510334 | Loftin Eyecare, LLC | Optometrist | 724 West Stadium Boulevard, # 029 Walmart Vision Center, Jefferson City, MO 65109 | 2010-10-19 |
| 1306077250 | Paula Hancock Johnson | Social Worker | 1303 Edgewood Dr Ste 5, Jefferson City, MO 65109 | 2009-07-27 |
| 1679701296 | Capital Region Medical Center | Family Medicine | 3308 W Edgewood, Suite B, Jefferson City, MO 65109 | 2009-06-23 |
| 1972730141 | Nancy S Stork | Counselor | 204 Metro, Suite B, Jefferson City, MO 65109 | 2009-06-16 |
| 1356522916 | Walk Easy LLC | Durable Medical Equipment & Medical Supplies | 4810 Rainbow Dr., Jefferson City, MO 65109 | 2007-11-23 |
| Find all providers in zip 65109 | ||||
| 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 |
|---|---|---|---|---|
| 1518177591 | Missouri Veterans Commission | Skilled Nursing Facility | 205 Jefferson St Fl 12, Jefferson City, MO 65101-2901 | 2007-05-22 |
| 1356556625 | Lutheran Senior Services | Skilled Nursing Facility | 1306 W Main St, Jefferson City, MO 65109-1356 | 2007-05-11 |
| 1851415905 | Oak Tree Villas, Inc | Skilled Nursing Facility | 3801 West Truman Blvd, Jefferson City, MO 65109 | 2007-03-16 |
| 1245378371 | Adams Street Place, Inc. | Skilled Nursing Facility | 1024 Adams St, Jefferson City, MO 65101-3408 | 2007-02-01 |
| 1952476343 | Jefferson City Nursing and Rehabilitation Center, LLC | Skilled Nursing Facility | 1221 Southgate Ln, Jefferson City, MO 65109-2465 | 2006-11-21 |
| 1376574301 | Life Care Centers of America, Inc. | Skilled Nursing Facility | 336 W Old Andrew Johnson Hwy, Jefferson City, TN 37760-5212 | 2006-07-06 |
| 1730131897 | Otke-villa LLC | Skilled Nursing Facility | 1030 Edmonds St, Jefferson City, MO 65109-5213 | 2006-05-17 |
| 1932159308 | Ggnsc Jefferson City LLC | Skilled Nursing Facility | 3038 W Truman Blvd, Jefferson City, MO 65109-0525 | 2006-05-10 |
| 1205381373 | N & R of Jefferson City LLC | Skilled Nursing Facility | 3038 W Truman Blvd, Jefferson City, MO 65109-0525 | 2016-08-18 |
| 1093176950 | Jefferson City Operations, LLC | Skilled Nursing Facility | 336 W Old Andrew Johnson Hwy, Jefferson City, TN 37760-5212 | 2016-03-18 |
| Find all providers in JEFFERSON CITY | ||||
| City | JEFFERSON CITY |
| Zip Code | 65109 |
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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.