LICKING PARK MANOR
NPI 1609996222
Skilled Nursing Facility in Licking, MO

Active since March 29, 2007CLIA 26D0652411 · Waiver
209 HICKORY ST, LICKING, MO 65542(573) 674-2111 Get Directions Write a Review

NPPES record last updated: January 10, 2008. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Licking Park Manor NPPES

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

LICKING PARK MANOR (NPI 1609996222) is a healthcare organization registered as a skilled nursing facility in Licking, Missouri and active in the NPI registry since March 2007. The organization holds a CLIA Waiver certificate valid through August 31, 2026 and lists James J Giardina, President, as its authorized official.

NPPES Registry Identity

NPI1609996222
Entity TypeOrganization
Primary Taxonomy314000000X
Legal Business NameCOMMUNITY CARE CENTER OF LICKING INC
Location Address209 HICKORY STLicking, MO 65542-9847
Mailing Address312 Solley Dr RearBallwin, MO 63021-5248 · (636) 394-3000
Organization SubpartNo
Authorized OfficialJames J GiardinaPresident · (636) 394-3000
Enumeration DateMarch 29, 2007
Last NPPES UpdateJanuary 10, 2008
NPI 1609996222 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtySkilled Nursing FacilityNursing & Custodial Care Facilities
Taxonomy Code314000000X
License Licensed in MO · 035084
Definition
(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.
209 HICKORY ST, Licking, MO 65542

Other Names 1

Doing Business AsLicking Park Manor

Other Identifiers 1

Medicare OSCAR/certification265632MO

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 26D0652411

Licking No 1 Dba Hickory Manor · Licking, MO
Active · expires Aug 31, 2026
CLIA Number26D0652411
Laboratory TypeSkilled Nursing Facility/Nursing Facility
Certificate Effective DateSeptember 1, 2024
Certificate Expiration DateAugust 31, 2026
Laboratory DirectorLindi Schmitt
Laboratory Phone(573) 674-2111
Laboratory LocationLicking No 1 Dba Hickory Manor209 Hickory, Licking, MO 65542
CLIA data matches this NPI record on: Address Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Speech-Language Pathologist
209 HICKORY ST
LICKING, MO 65542
Skilled Nursing Facility
209 HICKORY ST
LICKING, MO 65542

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 Community Care Center Of Licking Inc's NPI number?

The NPI number for Community Care Center Of Licking Inc is 1609996222. It was assigned to this organization in the NPPES registry on March 29, 2007. The provider is doing business as Licking Park Manor.

Where is Community Care Center Of Licking Inc located?

Community Care Center Of Licking Inc is located at 209 Hickory St, Licking, MO 65542. The listed phone number is (573) 674-2111.

What is Community Care Center Of Licking Inc's specialty?

The primary specialty registered for this NPI is Skilled Nursing Facility with taxonomy code 314000000X.

Does Community Care Center Of Licking Inc hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 26D0652411) is associated with this NPI, valid through August 31, 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 Community Care Center Of Licking Inc was last updated on January 10, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 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.