MADISON MEDICAL CENTER STOCKHOFF MEMORIAL NURSING HOME (NPI# 1215003041) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1215003041 |
| Entity Type | Organization |
| Organization Name | MADISON MEDICAL CENTER STOCKHOFF MEMORIAL NURSING HOME |
| Other Organization Name | MADISON MEDICAL CENTER |
| Practice Address |
611 West Main Street Fredericktown MO 63645 |
| Practice Telephone | 5737833341 |
| Practice Fax Number | 5737831096 |
| Mailing Telephone | 5737833341 |
| Mailing Fax Number | 5737831096 |
| Enumeration Date | 2006-11-24 |
| Last Update Date | 2014-01-02 |
| Authorized Official Name | MRS. LISA MARIE TWIDWELL (CEO) |
| Authorized Official Telephone | 5737833341 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 313M00000X | Nursing Facility/Intermediate Care Facility | 20945 | MO | Nursing & Custodial Care Facilities |
| Y | 314000000X | Skilled Nursing Facility | 20945 | MO | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MO | 101458008 | 05 |
| Other Name | Type Code |
|---|---|
| Madison Medical Center | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649357229 | Madison Medical Center Stockhoff Memorial Nursing Home | Clinic/Center | 200 St. Mary, Pilot Knob, MO 63663-0523 | 2006-11-01 |
| 1467539031 | Madison Medical Center Stockhoff Memorial Nursing Home | Clinic/Center | 611 West Main Street, Fredericktown, MO 63645 | 2006-11-01 |
| 1750457586 | Madison Medical Center Stockhoff Memorial Nursing Home | Home Health | 611 West Main Street, Fredericktown, MO 63645 | 2006-11-24 |
| 1316013139 | Madison Medical Center Stockhoff Memorial Nursing Home | Medicare Defined Swing Bed Unit | 611 West Main Street, Fredericktown, MO 63645 | 2006-11-24 |
| 1720163025 | Madison Medical Center Stockhoff Memorial Nursing Home | General Acute Care Hospital | 611 W Main St, Fredericktown, MO 63645-1111 | 2006-10-26 |
| Street Address |
611 WEST MAIN STREET |
| City | FREDERICKTOWN |
| State | MO |
| Zip Code | 63645 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467539031 | Madison Medical Center Stockhoff Memorial Nursing Home | Clinic/Center | 611 West Main Street, Fredericktown, MO 63645 | 2006-11-01 |
| 1235392309 | Humberto Jose Olivero Lara | Family Medicine | 611 West Main Street, Fredericktown, MO 63645 | 2008-07-08 |
| 1043490857 | Julie Marie Buford | Nurse Practitioner | 611 West Main Street, Suite E, Fredericktown, MO 63645-1111 | 2007-11-08 |
| 1003983859 | Madison Memorial Hospital Stockhoff Memorial Nursing Home | Pharmacy | 611 West Main Street, Fredericktown, MO 63645 | 2006-11-29 |
| 1750457586 | Madison Medical Center Stockhoff Memorial Nursing Home | Home Health | 611 West Main Street, Fredericktown, MO 63645 | 2006-11-24 |
| 1316013139 | Madison Medical Center Stockhoff Memorial Nursing Home | Medicare Defined Swing Bed Unit | 611 West Main Street, Fredericktown, MO 63645 | 2006-11-24 |
| 1225104045 | Madison Memorial Hospital Stockhoff Memorial Nursing Home | Homemaker | 611 West Main Street, Fredericktown, MO 63645 | 2006-11-24 |
| 1851467674 | Madison Memorial Hospital Stockhoff Memorial Nursing Home | Technician | 611 West Main Street, Fredericktown, MO 63645 | 2006-11-24 |
| 1306912134 | Madison Memorial Hospital Stockhoff Memorial Nursing Home | Ambulance | 611 West Main Street, Fredericktown, MO 63645 | 2006-11-24 |
| 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 |
| 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 |
| 1619081593 | Angela R Menz | Nurse Practitioner | 611 W Main St, Fredericktown, MO 63645 | 2006-08-18 |
| 1811439227 | Bali Rae Hoover-richardson | Counselor | 1800 County Road 257, Fredericktown, MO 63645-0025 | 2016-11-16 |
| 1154673887 | Wagner Residential Care Inc | Assisted Living Facility | 320 N Chamber Dr, Fredericktown, MO 63645-0320 | 2012-10-04 |
| Find all providers in zip 63645 | ||||
| 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 |
|---|---|---|---|---|
| 1447248927 | Levering Management, Inc. | Skilled Nursing Facility | 115 North Portland Street, Fredericktown, OH 43019-9378 | 2005-10-10 |
| 1366438731 | N & R of Fredericktown, Inc. | Skilled Nursing Facility | 105 Spruce St, Fredericktown, MO 63645-1002 | 2005-09-21 |
| 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 |
| Find all providers with the same taxonomy | ||||
| City | FREDERICKTOWN |
| Zip Code | 63645 |
Please comment or provide details below to improve the information on MADISON MEDICAL CENTER STOCKHOFF MEMORIAL NURSING HOME.
| 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.