GOLDEN AGE NURSING HOME DISTRICT (NPI# 1043208796) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1043208796 |
| Entity Type | Organization |
| Organization Name | GOLDEN AGE NURSING HOME DISTRICT |
| Practice Address |
12498 Se Highway 116 Braymer MO 64624-9107 |
| Practice Telephone | 6606452243 |
| Practice Fax Number | 6606452719 |
| Mailing Telephone | 6606452243 |
| Mailing Fax Number | 6606452719 |
| Enumeration Date | 2005-10-06 |
| Last Update Date | 2011-11-21 |
| Authorized Official Name | MS. TAMMY J MURDOCK (ADMINISTRATOR) |
| Authorized Official Telephone | 6606452243 |
| Authorized Official Credential | LPN |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 314000000X | Skilled Nursing Facility | 038984 | MO | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MO | 101487106 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790770444 | Golden Age Nursing Home District | Skilled Nursing Facility | 404 E 3rd, Stover, MO 65078 | 2005-09-19 |
| Street Address |
12498 SE HIGHWAY 116 |
| City | BRAYMER |
| State | MO |
| Zip Code | 64624-9107 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588283196 | Hillary Marie Simpson | Physical Therapist | 12498 Se Highway 116, Braymer, MO 64624-9107 | 2020-04-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215059209 | Northwest Health Services, Inc | Family Medicine | 109 Main Street, Braymer, MO 64624 | 2007-04-03 |
| 1033284955 | Daniel Scott Pennington | Chiropractor | 209 Main Street, Braymer, MO 64624 | 2006-11-24 |
| 1477520690 | Dorothy Milburn | Nurse Practitioner | 109 Main Street, Braymer, MO 64624-0036 | 2006-03-07 |
| 1043785470 | Katelynn R Crawford | Nurse Practitioner | 109 N Main St, Braymer, MO 64624-9325 | 2018-10-12 |
| 1902336431 | Carolyn Ann Blackburn | Registered Nurse | 109 N Main St, Braymer, MO 64624-9325 | 2017-06-18 |
| 1003013111 | Braymer C-4 School | Local Education Agency (LEA) | 400 Bobcat Ave, Braymer, MO 64624-9750 | 2007-07-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003013111 | Braymer C-4 School | Local Education Agency (LEA) | 400 Bobcat Ave, Braymer, MO 64624-9750 | 2007-07-02 |
| 1043785470 | Katelynn R Crawford | Nurse Practitioner | 109 N Main St, Braymer, MO 64624-9325 | 2018-10-12 |
| 1902336431 | Carolyn Ann Blackburn | Registered Nurse | 109 N Main St, Braymer, MO 64624-9325 | 2017-06-18 |
| 1215059209 | Northwest Health Services, Inc | Family Medicine | 109 Main Street, Braymer, MO 64624 | 2007-04-03 |
| 1033284955 | Daniel Scott Pennington | Chiropractor | 209 Main Street, Braymer, MO 64624 | 2006-11-24 |
| 1477520690 | Dorothy Milburn | Nurse Practitioner | 109 Main Street, Braymer, MO 64624-0036 | 2006-03-07 |
| 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 |
|---|---|---|---|---|
| 1609492719 | Ignite Medical Resort Independence LLC | Skilled Nursing Facility | 20511 E. Trinity Pl., Blue Springs, MO 64015 | 2020-06-24 |
| 1760006308 | Sunterra Dardenne Prairie Oc LLC | Skilled Nursing Facility | 7275 Highway N, Dardenne Prairie, MO 63368-7126 | 2020-05-29 |
| 1184247215 | Berry Medical Properties, LLC | Skilled Nursing Facility | 11380 Natural Bridge Rd, Bridgeton, MO 63044-2307 | 2020-05-23 |
| 1881249464 | Rolla Grand LLC | Skilled Nursing Facility | 1800 White Columns Dr, Rolla, MO 65401-2044 | 2019-08-09 |
| 1184276982 | Willow Health Care Inc | Skilled Nursing Facility | 712 Copper Rock Dr, Rogersville, MO 65742-8970 | 2019-07-11 |
| 1548734627 | Medicore Medical Service LLC | Skilled Nursing Facility | 2303 Kratky Rd Apt B, Saint Louis, MO 63114-1783 | 2019-01-11 |
| 1518436724 | Missouri Nursing & Rehab LLC | Skilled Nursing Facility | 783 Weber Road, Farmington, MO 63640-3318 | 2018-11-16 |
| 1982172342 | Arrowhead Retirement Operations LLC | Skilled Nursing Facility | 6100 Arrowhead Drive, Osage Beach, MO 65065 | 2018-11-05 |
| 1578039467 | Laverna Senior Living LLC | Skilled Nursing Facility | 904 S Hall Ave, Savannah, MO 64485-1952 | 2018-10-17 |
| 1093297152 | Community Care Center of Union Inc | Skilled Nursing Facility | 1080 Marie Lane, Union, MO 63084 | 2018-09-05 |
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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.