MEDICARE: N & R OF FREDERICKTOWN, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	029883	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	16780698	OTHER	MO	STATE ID
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366438731
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	N & R OF FREDERICKTOWN, INC.

Provider Business Mailing Address
First Line	:	105 SPRUCE ST
Second Line	:
City	:	FREDERICKTOWN
State	:	MO
Zip	:	63645-1002
Country	:	US
Telephone Number	:	573-783-3993
Fax Number	:	573-783-5092

Provider Business Practice Location Address
First Line	:	105 SPRUCE ST
Second Line	:
City	:	FREDERICKTOWN
State	:	MO
Zip	:	63645-1002
Country	:	US
Telephone Number	:	573-783-3993
Fax Number	:	573-783-5092

Authorized Official
Title or Position	:	CFO
Name	:	CARLA HEDRICK
Credential	:
Telephone Number	:	573-481-9625

Provider Enumeration Date	:	09/21/2005
Last Update Date	:	08/13/2025

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