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General NPI Number Information
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NPI Number | 1245068154
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Entity Type | Organization
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Legal Business Name | BLEAURIDGE NURSING AND REHAB LLC
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Dates
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Enumeration Date | 07/23/2024
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Last Update Date | 07/23/2024
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Provider Practice Location Address
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Address Line | 1003 CEDAR ST
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City | BELTON
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State | MO
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Zip | 64012
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Country | US
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Telephone | 816-331-0781
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Fax |
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Provider Business Mailing Address
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Address Line | 2215 BROADWAY ST
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City | CAPE GIRARDEAU
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State | MO
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Zip | 63701-4403
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Country | US
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Telephone | 573-335-3044
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Fax | 573-335-6724
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. SHAFIQ MALIK
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Credential |
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Telephone | 573-335-3044
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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 |
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License Number State |
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