Healthcare Provider Details

I. General information

NPI: 1225024581
Provider Name (Legal Business Name): N & R OF OAK GROVE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

2108 SW MITCHELL ST
OAK GROVE MO
64075-9472
US

IV. Provider business mailing address

2108 SW MITCHELL ST
OAK GROVE MO
64075-9472
US

V. Phone/Fax

Practice location:
  • Phone: 816-690-4118
  • Fax: 816-690-8680
Mailing address:
  • Phone: 816-690-4118
  • Fax: 816-690-8680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number031362
License Number StateMO

VIII. Authorized Official

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