Healthcare Provider Details

I. General information

NPI: 1922007277
Provider Name (Legal Business Name): R. DEVELOPMENT, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4359 TAFT AVE
SAINT LOUIS MO
63116-1533
US

IV. Provider business mailing address

4359 TAFT AVE
SAINT LOUIS MO
63116-1533
US

V. Phone/Fax

Practice location:
  • Phone: 314-752-2022
  • Fax: 314-752-7679
Mailing address:
  • Phone: 314-752-2022
  • Fax: 314-752-7679

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number030570
License Number StateMO

VIII. Authorized Official

Name: MRS. MICHELLE S. HASSAN
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 314-752-2022