COMMUNITY CARE CTR OF SULLIVAN, INC (NPI# 1063419505) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063419505 |
| Entity Type | Organization |
| Organization Name | COMMUNITY CARE CTR OF SULLIVAN, INC |
| Other Organization Name | MERAMEC NURSING CENTER |
| Practice Address |
940 Mattox Dr Sullivan MO 63080-2364 |
| Mailing Address |
312 Solley Dr Rear Ballwin MO 63021-5248 |
| Practice Telephone | 5734687733 |
| Practice Fax Number | 5738603168 |
| Mailing Telephone | 6363943000 |
| Mailing Fax Number | 6363947713 |
| Enumeration Date | 2005-06-30 |
| Last Update Date | 2014-07-09 |
| Authorized Official Name | JAMES GIARDINA (PRESIDENT) |
| Authorized Official Telephone | 6363943000 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 314000000X | Skilled Nursing Facility | 033721 | MO | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MO | 106830706 | 05 |
| Other Name | Type Code |
|---|---|
| Meramec Nursing Center | Doing Business As Name - Organization |
| Street Address |
940 MATTOX DR |
| City | SULLIVAN |
| State | MO |
| Zip Code | 63080-2364 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356968549 | Sarah Marx | Speech-Language Pathologist | 940 Mattox Dr, Sullivan, MO 63080-2364 | 2020-07-03 |
| 1609344886 | Karlie Wilmesher | Occupational Therapist | 940 Mattox Dr, Sullivan, MO 63080-2364 | 2018-11-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669896650 | Lindsay Nicole Arnette | Physical Therapist | 940 Mattox Drive, Meramec Nursing Center, Sullivan, MO 63080 | 2014-02-11 |
| 1407099500 | Victorian Manor of Sullivan | Assisted Living Facility | 1250 East Springfield Rd, Sullivan, MO 63080 | 2009-04-20 |
| 1578729992 | Bio-medical Applications of Missouri, Inc. | Clinic/Center | 123 Progress Parkway, Sullivan, MO 63080 | 2008-08-05 |
| 1386826089 | Sellers Family Chiropractic PC | Chiropractor | 405 Wal Mart Drive, Sullivan, MO 63080 | 2007-12-04 |
| 1740495282 | Tasha Marie Rodriguez | Physical Therapist | 107 Congress Dr., Sullivan, MO 63080 | 2007-05-10 |
| 1033261649 | Clyde William Sellers II | Chiropractor | 405 Walmart Dr., Sullivan, MO 63080 | 2007-01-17 |
| 1407954209 | Sara Skidmore | Occupational Therapist | 2022 Phoenix Drive, Sullivan, MO 63080 | 2006-09-20 |
| 1083724116 | Sharon A Titter | Physical Therapist | 107 Progress Dr, Sullivan, MO 63080 | 2006-08-30 |
| 1437135571 | Thanh Duy Vo | Pediatrics | 486 N Church St, Sullivan, MO 63080 | 2005-12-20 |
| 1508849316 | Air Evac Ems Inc | Ambulance | 673 Sappington Bridge Rd, Sullivan, MO 63080 | 2005-11-25 |
| Find all providers in zip 63080 | ||||
| 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 |
|---|---|---|---|---|
| 1568419232 | Sullivan Operations, LLC | Skilled Nursing Facility | 875 Dunsford Dr, Sullivan, MO 63080-1238 | 2006-05-28 |
| 1417913583 | Sullivan Hco, LLC | Skilled Nursing Facility | 11 Hawthorne Ln, Sullivan, IL 61951-9490 | 2006-04-26 |
| 1710952866 | Sullivan Health & Living Center, Inc. | Skilled Nursing Facility | 325 W Northwood Dr, Sullivan, IN 47882-7515 | 2006-02-22 |
| 1194703702 | Petersen Health Care Vii LLC | Skilled Nursing Facility | 1 Masonic Way, Sullivan, IL 61951-9467 | 2006-01-04 |
| 1811984644 | Eastview Terrace | Skilled Nursing Facility | 100 Eastview Pl, Sullivan, IL 61951-1674 | 2005-10-06 |
| 1063045227 | Eastview Hco, LLC | Skilled Nursing Facility | 100 Eastview Pl, Sullivan, IL 61951-1674 | 2020-02-17 |
| 1386277556 | Sullivan Hco, LLC | Skilled Nursing Facility | 11 Hawthorne Ln, Sullivan, IL 61951-9490 | 2020-02-17 |
| 1609027846 | Petersen Health Care, Inc | Skilled Nursing Facility | 100 Eastview Pl, Sullivan, IL 61951-1674 | 2008-10-07 |
| 1376794511 | Petersen Health Care II, Inc. | Skilled Nursing Facility | 11 Hawthorne Ln, Sullivan, IL 61951-9490 | 2008-10-07 |
| 1013193903 | Witham Memorial Hospital | Skilled Nursing Facility | 325 W Northwood Dr, Sullivan, IN 47882-7515 | 2008-01-10 |
| Find all providers in SULLIVAN | ||||
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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.