Healthcare Provider Details

I. General information

NPI: 1063799153
Provider Name (Legal Business Name): ROSE MISSOURI NURSING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2011
Last Update Date: 11/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

812 OLD EXETER RD
CASSVILLE MO
65625-1704
US

IV. Provider business mailing address

812 OLD EXETER RD
CASSVILLE MO
65625-1704
US

V. Phone/Fax

Practice location:
  • Phone: 417-847-2184
  • Fax: 417-847-2642
Mailing address:
  • Phone: 417-847-2184
  • Fax: 417-847-2642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number039678
License Number StateMO

VIII. Authorized Official

Name: BOYD P GENTRY
Title or Position: PRESIDENT & CEO
Credential:
Phone: 937-964-8974