Healthcare Provider Details

I. General information

NPI: 1780923318
Provider Name (Legal Business Name): N & R OF ST CHARLES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2013
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 BOONES LICK RD
SAINT CHARLES MO
63301-2328
US

IV. Provider business mailing address

PO BOX 1559
SIKESTON MO
63801-1559
US

V. Phone/Fax

Practice location:
  • Phone: 636-946-6140
  • Fax: 636-757-1141
Mailing address:
  • Phone: 573-481-9625
  • Fax: 573-481-0773

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number101482206
License Number StateMO

VIII. Authorized Official

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