Provider Demographics
NPI:1033994983
Name:4TH GENERATION RCF LLC
Entity Type:Organization
Organization Name:4TH GENERATION RCF LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:NACOLE
Authorized Official - Middle Name:M
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-971-9784
Mailing Address - Street 1:3258 REX AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63114-2927
Mailing Address - Country:US
Mailing Address - Phone:314-971-9784
Mailing Address - Fax:314-382-2094
Practice Address - Street 1:2320 HUDSON RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63136-5608
Practice Address - Country:US
Practice Address - Phone:314-971-9784
Practice Address - Fax:314-382-2094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-29
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility