WAGNER RESIDENTIAL CARE INC
NPI 1154673887
Assisted Living Facility in Fredericktown, MO

Q: What is Wagner Residential Care Inc's NPI number?

The NPI number for Wagner Residential Care Inc is 1154673887. It was assigned to this organization in the NPPES registry on October 4, 2012.

Q: What is Wagner Residential Care Inc's specialty?

The primary specialty registered for this NPI is Assisted Living Facility with taxonomy code 310400000X.

Active since October 04, 2012CLIA 26D2121569 · Waiver

320 N CHAMBER DR, FREDERICKTOWN, MO 63645(573) 783-4511(573) 783-4513 Get Directions Write a Review

NPPES record last updated: April 4, 2016. Verified against the NPPES registry weekly; last sync: September 20, 2026.

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About Wagner Residential Care Inc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

WAGNER RESIDENTIAL CARE INC (NPI 1154673887) is a healthcare organization registered as an assisted living facility in Fredericktown, Missouri and active in the NPI registry since October 2012. The organization holds a CLIA Waiver certificate valid through November 7, 2026 and lists Teena Wagner, Owner/manager, as its authorized official.

NPPES Registry Identity

NPI1154673887

Entity TypeOrganization

Primary Taxonomy310400000X

Legal Business NameWAGNER RESIDENTIAL CARE INC

Location Address320 N CHAMBER DRFredericktown, MO 63645-0320

Mailing Address320 N Chamber DrFredericktown, MO 63645-0320 · (573) 783-4511 · Fax (573) 783-4513

Phone(573) 783-4511

Fax(573) 783-4513

Organization SubpartNo

Authorized OfficialTeena WagnerOwner/manager · (573) 783-4511

Enumeration DateOctober 4, 2012

Last NPPES UpdateApril 4, 2016

✔ NPI 1154673887 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyAssisted Living FacilityNursing & Custodial Care Facilities

Taxonomy Code310400000X

License✔ Licensed in MO · 040545

Definition

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.

320 N CHAMBER DR, Fredericktown, MO 63645

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CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 26D2121569

Wagner Residential Care Inc · Fredericktown, MO

Active · expires Nov 7, 2026

CLIA Number26D2121569

Laboratory TypeAssisted Living Facility

Certificate Effective DateNovember 8, 2024

Certificate Expiration DateNovember 7, 2026

Laboratory DirectorTeena D. Wagner

Laboratory Phone(573) 783-4511

Laboratory LocationWagner Residential Care Inc320 N Chamber Dr, Fredericktown, MO 63645

CLIA data matches this NPI record on: Address Name Phone

This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Wagner Residential Care Inc's NPI number?

The NPI number for Wagner Residential Care Inc is 1154673887. It was assigned to this organization in the NPPES registry on October 4, 2012.

Where is Wagner Residential Care Inc located?

Wagner Residential Care Inc is located at 320 N Chamber Dr, Fredericktown, MO 63645. The listed phone number is (573) 783-4511.

What is Wagner Residential Care Inc's specialty?

The primary specialty registered for this NPI is Assisted Living Facility with taxonomy code 310400000X.

Does Wagner Residential Care Inc hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 26D2121569) is associated with this NPI, valid through November 7, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Wagner Residential Care Inc was last updated on April 4, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.