Healthcare Provider Details

I. General information

NPI: 1073068151
Provider Name (Legal Business Name): N & R OF ST JAMES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2016
Last Update Date: 09/16/2025
Certification Date: 09/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 SIDNEY ST
SAINT JAMES MO
65559-1070
US

IV. Provider business mailing address

415 SIDNEY ST
SAINT JAMES MO
65559-1070
US

V. Phone/Fax

Practice location:
  • Phone: 573-265-8921
  • Fax: 573-265-5133
Mailing address:
  • Phone: 573-265-8921
  • Fax: 573-265-5133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number042091
License Number StateMO

VIII. Authorized Official

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