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General NPI Number Information
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NPI Number | 1215901921
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Entity Type | Organization
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Legal Business Name | VIENNA NURSING & REHAB LLC
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Dates
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Enumeration Date | 02/17/2006
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Last Update Date | 09/15/2025
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Provider Practice Location Address
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Address Line | 174 BALLPARK ROAD
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City | VIENNA
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State | MO
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Zip | 65582-8043
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Country | US
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Telephone | 573-422-3177
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Fax | 573-422-3079
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Provider Business Mailing Address
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Address Line | 174 BALLPARK RD
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City | VIENNA
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State | MO
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Zip | 65582-8043
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Country | US
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Telephone | 573-422-3177
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Fax | 573-422-3079
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Authorized Official
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Title or Position | CFO
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Name | CARLA HEDRICK
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Credential | CFO
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Telephone | 573-481-9625
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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 | 028504
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 035364
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License Number State | MO
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