MEDICARE: N & R OF MALDEN, LLC

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	030260	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
2	17807701	OTHER	MO	STATE ID

General Provider Information

NPI Number	:	1922094218
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	N & R OF MALDEN, LLC

Provider Business Mailing Address
First Line	:	1209 STOKELAN DR
Second Line	:
City	:	MALDEN
State	:	MO
Zip	:	63863-1335
Country	:	US
Telephone Number	:	573-276-5115
Fax Number	:	573-246-5292

Provider Business Practice Location Address
First Line	:	1209 STOKELAN DR
Second Line	:
City	:	MALDEN
State	:	MO
Zip	:	63863-1335
Country	:	US
Telephone Number	:	573-276-5115
Fax Number	:	573-276-5292

Authorized Official
Title or Position	:	SHAREHOLDER
Name	:	MR. JAMES C LINCOLN
Credential	:
Telephone Number	:	573-746-7100

Provider Enumeration Date	:	09/22/2005
Last Update Date	:	11/04/2011

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