Healthcare Provider Details

I. General information

NPI: 1598751943
Provider Name (Legal Business Name): N & R OF FULTON, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2005
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 N BLUFF ST
FULTON MO
65251-2352
US

IV. Provider business mailing address

1510 N BLUFF ST
FULTON MO
65251-2352
US

V. Phone/Fax

Practice location:
  • Phone: 573-642-0202
  • Fax: 573-642-6207
Mailing address:
  • Phone: 573-642-0202
  • Fax: 573-642-6207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number029715
License Number StateMO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier16773641
Identifier TypeOTHER
Identifier StateMO
Identifier IssuerSTATE ID
# 2
Identifier101776805
Identifier TypeMEDICAID
Identifier StateMO
Identifier Issuer

VIII. Authorized Official

Name: CARLA HEDRICK
Title or Position: CFO
Credential: CFO
Phone: 573-481-9625