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General NPI Number Information
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NPI Number | 1063799153
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Entity Type | Organization
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Legal Business Name | ROSE MISSOURI NURSING, LLC
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Dates
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Enumeration Date | 11/03/2011
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Last Update Date | 11/03/2011
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Provider Practice Location Address
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Address Line | 812 OLD EXETER RD
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City | CASSVILLE
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State | MO
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Zip | 65625-1704
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Country | US
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Telephone | 417-847-2184
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Fax | 417-847-2642
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Provider Business Mailing Address
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Address Line | 812 OLD EXETER RD
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City | CASSVILLE
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State | MO
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Zip | 65625-1704
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Country | US
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Telephone | 417-847-2184
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Fax | 417-847-2642
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Authorized Official
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Title or Position | PRESIDENT & CEO
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Name | BOYD P GENTRY
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Credential |
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Telephone | 937-964-8974
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 039678
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License Number State | MO
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