=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558397661
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | N & R OF CRESTVIEW LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/23/2006
-----------------------------------------------------
Last Update Date | 09/15/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1313 SOUTH 25TH STREET
-----------------------------------------------------
City | BETHANY
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64424
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 660-425-3138
-----------------------------------------------------
Fax | 660-425-6922
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | BOX 430 1313 SOUTH 25TH STREET
-----------------------------------------------------
City | BETHANY
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64424
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 660-425-3138
-----------------------------------------------------
Fax | 660-425-6922
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | CARLA HEDRICK
-----------------------------------------------------
Credential | CFO
-----------------------------------------------------
Telephone | 573-481-9625
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number | 031793
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number | 34647
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------