Healthcare Provider Details

I. General information

NPI: 1790771012
Provider Name (Legal Business Name): N & R OF PLATTE CITY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2005
Last Update Date: 10/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 OROURKE DR
PLATTE CITY MO
64079-9360
US

IV. Provider business mailing address

220 OROURKE DR
PLATTE CITY MO
64079-9360
US

V. Phone/Fax

Practice location:
  • Phone: 636-586-3022
  • Fax: 636-586-1440
Mailing address:
  • Phone: 636-586-3022
  • Fax: 636-586-1440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number029737
License Number StateMO

VII. Legacy identifiers

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

# 1
Identifier16742320
Identifier TypeOTHER
Identifier StateMO
Identifier IssuerSTATE ID
# 2
Identifier102341302
Identifier TypeMEDICAID
Identifier StateMO
Identifier Issuer

VIII. Authorized Official

Name: MR. JAMES C LINCOLN
Title or Position: SHAREHOLDER
Credential:
Phone: 573-746-7100