Healthcare Provider Details

I. General information

NPI: 1831185131
Provider Name (Legal Business Name): N & R OF EAST PRAIRIE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2005
Last Update Date: 04/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

186 MILLAR RD
EAST PRAIRIE MO
63845-1180
US

IV. Provider business mailing address

186 MILLAR RD
EAST PRAIRIE MO
63845-1180
US

V. Phone/Fax

Practice location:
  • Phone: 573-649-3551
  • Fax: 573-649-3552
Mailing address:
  • Phone: 573-649-3551
  • Fax: 573-649-3552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number029449
License Number StateMO

VIII. Authorized Official

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