Provider Demographics
NPI:1285782342
Name:LAURIE CARE CENTER
Entity type:Organization
Organization Name:LAURIE CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LORRI
Authorized Official - Middle Name:M
Authorized Official - Last Name:STEFFEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-374-8263
Mailing Address - Street 1:PO BOX 1068
Mailing Address - Street 2:
Mailing Address - City:LAURIE
Mailing Address - State:MO
Mailing Address - Zip Code:65038-1068
Mailing Address - Country:US
Mailing Address - Phone:573-374-8263
Mailing Address - Fax:573-374-0603
Practice Address - Street 1:610 HWY O
Practice Address - Street 2:
Practice Address - City:LAURIE
Practice Address - State:MO
Practice Address - Zip Code:65038-1068
Practice Address - Country:US
Practice Address - Phone:573-374-8263
Practice Address - Fax:573-374-0603
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GOOD SHEPHERD NURSING HOME DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-08
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO032349314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO101455103Medicaid
265737Medicare Oscar/Certification