Provider Demographics
NPI:1003361189
Name:N & R OF BRANSON LLC
Entity Type:Organization
Organization Name:N & R OF BRANSON LLC
Other - Org Name:SHEPHERD OF THE HILLS LIVING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MATHIAS
Authorized Official - Middle Name:P
Authorized Official - Last Name:DASAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-481-9625
Mailing Address - Street 1:996 STATE HIGHWAY 248
Mailing Address - Street 2:
Mailing Address - City:BRANSON
Mailing Address - State:MO
Mailing Address - Zip Code:65616-8154
Mailing Address - Country:US
Mailing Address - Phone:417-334-6431
Mailing Address - Fax:417-334-6460
Practice Address - Street 1:996 STATE HIGHWAY 248
Practice Address - Street 2:
Practice Address - City:BRANSON
Practice Address - State:MO
Practice Address - Zip Code:65616-8154
Practice Address - Country:US
Practice Address - Phone:417-334-6431
Practice Address - Fax:417-334-6460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-18
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO043855314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO101452704Medicaid
CA265393Medicare Oscar/Certification