MEDICARE: N & R OF CALIFORNIA WEST, 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	031405	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	18014208	OTHER	MO	STATE ID
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861488116
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	N & R OF CALIFORNIA WEST, LLC

Provider Business Mailing Address
First Line	:	200 S GERHART RD
Second Line	:
City	:	CALIFORNIA
State	:	MO
Zip	:	65018-2433
Country	:	US
Telephone Number	:	573-796-3822
Fax Number	:	573-796-2715

Provider Business Practice Location Address
First Line	:	200 S GERHART RD
Second Line	:
City	:	CALIFORNIA
State	:	MO
Zip	:	65018-2433
Country	:	US
Telephone Number	:	573-796-3822
Fax Number	:	573-796-2715

Authorized Official
Title or Position	:	MEMBER
Name	:	MR. JAMES C LINCOLN
Credential	:
Telephone Number	:	573-746-7100

Provider Enumeration Date	:	09/22/2005
Last Update Date	:	10/31/2011

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