Healthcare Provider Details

I. General information

NPI: 1629013172
Provider Name (Legal Business Name): NHC HEALTHCARE-DESLOGE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 02/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 BRIM ST
DESLOGE MO
63601-3441
US

IV. Provider business mailing address

801 BRIM ST
DESLOGE MO
63601-3441
US

V. Phone/Fax

Practice location:
  • Phone: 573-431-0223
  • Fax:
Mailing address:
  • Phone: 573-431-0223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number032609
License Number StateMO

VIII. Authorized Official

Name: MEL RECTOR
Title or Position: MANAGER
Credential:
Phone: 636-946-3677