BRISTOL MANOR OF BUFFALO
NPI 1053526665
Assisted Living Facility in Buffalo, MO

Active since May 14, 2007CLIA 26D0972136 · Waiver
1002 BIRCH ST, BUFFALO, MO 65622(417) 345-5500(417) 345-5500 Get Directions Write a Review

NPPES record last updated: October 2, 2007. Verified against the NPPES registry weekly; last sync: July 19, 2026.

  • Organization
  • Assisted Living Facility
  • CLIA Number: 26D0972136
  • CLIA Cert. Type: Assisted Living Facility
  • CLIA Exp. Date: 03-29-2028

About BRISTOL MANOR OF BUFFALO

This page provides the complete NPI Profile along with additional information for Bristol Manor Of Buffalo, a provider established in Buffalo, Missouri operating as a Assisted Living Facility. The healthcare provider is registered in the NPI registry with number 1053526665 assigned on May 2007. The practitioner's primary taxonomy code is 310400000X. The provider is registered as an organization and their NPI record was last updated 19 years ago. The provider's other name is Bristol Manor Of Buffalo. The authorized official of this NPI record is Mrs. Shelley Deanne Ebeling (Medicaid Billing Department)

NPI
1053526665 Verify this NPI
Provider Legal Name
BRISTOL CARE,INC.
Other Organization Name
BRISTOL MANOR OF BUFFALO
Other Name Type
Other Name (5)
Entity Type
Organization
Location Address
1002 BIRCH ST BUFFALO, MO 65622
Location Phone
(417) 345-5500
Location Fax
(417) 345-5500
Mailing Address
201 W 3RD ST SEDALIA, MO 65301
Mailing Phone
(660) 826-0200
Mailing Fax
(660) 827-2027
Is Sole Proprietor?
No
Is Organization Subpart?
No
Enumeration Date
05-14-2007
Last Update Date
10-02-2007
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Specialty - Primary Taxonomy

The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Classification

Assisted Living Facility

Taxonomy Code
310400000X
Type
Nursing & Custodial Care Facilities
Taxonomy Description
A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being.

Authorized Official

The authorized official is the designated individual with the legal authority to make changes to the provider’s official NPI record. For organizations, the authorized official must be a general partner, chairman of the board, CEO, CFO or a direct owner holding at least a 5 percent stake in the medical organization.

Authorized Official Name

MRS. SHELLEY DEANNE EBELING

Authorized Official Title
MEDICAID BILLING DEPARTMENT
Authorized Official Phone
(660) 826-0200

CLIA Information

The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:

CLIA Number
26D0972136
Facility Type
Assisted Living Facility
Certificate Effective Date
March 30, 2026
Certificate Expiration Date
March 29, 2028
Laboratory Director
LANDON WINBERRY
Certificate Type
Certificate of Waiver
Certificate Type Description
This CLIA certificate is issued to Bristol Manor Of Buffalo to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.

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Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1053526665, enumerated as an "organization" on May 14, 2007.

The provider is located at 1002 BIRCH ST BUFFALO, MO 65622 and the phone number is (417) 345-5500.

Assisted Living Facility with taxonomy code 310400000X.