MEDICARE: WESTERN MISSOURI NURSING AND REHAB LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1851091656
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WESTERN MISSOURI NURSING AND REHAB LLC

Provider Business Mailing Address
First Line	:	2215 BROADWAY ST
Second Line	:
City	:	CAPE GIRARDEAU
State	:	MO
Zip	:	63701-4403
Country	:	US
Telephone Number	:	573-335-3044
Fax Number	:	573-335-6724

Provider Business Practice Location Address
First Line	:	202 S WEST ST
Second Line	:
City	:	CONCORDIA
State	:	MO
Zip	:	64020-9643
Country	:	US
Telephone Number	:	660-463-2267
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SHAFIQ MALIK
Credential	:
Telephone Number	:	573-335-3044

Provider Enumeration Date	:	03/09/2023
Last Update Date	:	05/03/2023

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