Healthcare Provider Details

I. General information

NPI: 1215901921
Provider Name (Legal Business Name): VIENNA NURSING & REHAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

174 BALLPARK ROAD
VIENNA MO
65582-8043
US

IV. Provider business mailing address

174 BALLPARK RD
VIENNA MO
65582-8043
US

V. Phone/Fax

Practice location:
  • Phone: 573-422-3177
  • Fax: 573-422-3079
Mailing address:
  • Phone: 573-422-3177
  • Fax: 573-422-3079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number028504
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number035364
License Number StateMO

VIII. Authorized Official

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