MEDICARE: ROBERT JOSEPH MAKLER OWNER OF RCF

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	376G00000X	Nursing Home Administrator	EL-0996-INIT	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861910440
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT JOSEPH MAKLER OWNER OF RCF

Provider Business Mailing Address
First Line	:	614 WALMART DR STE 108
Second Line	:
City	:	FARMINGTON
State	:	MO
Zip	:	63640-3315
Country	:	US
Telephone Number	:	479-756-8601
Fax Number	:	573-246-6052

Provider Business Practice Location Address
First Line	:	3381 1ST ST
Second Line	:
City	:	DOE RUN
State	:	MO
Zip	:	63637-3155
Country	:	US
Telephone Number	:	573-760-8601
Fax Number	:	573-246-6052

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/05/2017
Last Update Date	:	09/05/2017

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