Healthcare Provider Details

I. General information

NPI: 1508852963
Provider Name (Legal Business Name): N & R OF CEDAR HILL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6400 THE CEDARS CT
CEDAR HILL MO
63016-2220
US

IV. Provider business mailing address

6400 THE CEDARS CT
CEDAR HILL MO
63016-2220
US

V. Phone/Fax

Practice location:
  • Phone: 636-274-1777
  • Fax: 636-274-4041
Mailing address:
  • Phone: 636-274-1777
  • Fax: 636-274-4041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number031642
License Number StateMO

VIII. Authorized Official

Name: THOMAS HUDSPETH
Title or Position: COO CFO
Credential:
Phone: 573-392-0316