Provider Demographics
NPI:1033458435
Name:N & R OF NORTH COLUMBIA LLC
Entity Type:Organization
Organization Name:N & R OF NORTH COLUMBIA LLC
Other - Org Name:COLUMBIA HEALTHCARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:C
Authorized Official - Last Name:LINCOLN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-481-9625
Mailing Address - Street 1:PO BOX 1559
Mailing Address - Street 2:
Mailing Address - City:SIKESTON
Mailing Address - State:MO
Mailing Address - Zip Code:63801-1559
Mailing Address - Country:US
Mailing Address - Phone:573-481-9625
Mailing Address - Fax:573-481-0773
Practice Address - Street 1:1801 TOWNE DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65202-2337
Practice Address - Country:US
Practice Address - Phone:573-474-6111
Practice Address - Fax:573-474-0680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-05
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO040882314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO101484400Medicaid
MO265251Medicare Oscar/Certification