Provider Demographics
NPI:1043206253
Name:N & R OF STRAFFORD, INC.
Entity Type:Organization
Organization Name:N & R OF STRAFFORD, INC.
Other - Org Name:STRAFFORD CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SHAREHOLDER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:C
Authorized Official - Last Name:LINCOLN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-746-7100
Mailing Address - Street 1:505 W EVERGREEN ST
Mailing Address - Street 2:
Mailing Address - City:STRAFFORD
Mailing Address - State:MO
Mailing Address - Zip Code:65757-8625
Mailing Address - Country:US
Mailing Address - Phone:417-736-9332
Mailing Address - Fax:417-736-9391
Practice Address - Street 1:505 W EVERGREEN ST
Practice Address - Street 2:
Practice Address - City:STRAFFORD
Practice Address - State:MO
Practice Address - Zip Code:65757-8625
Practice Address - Country:US
Practice Address - Phone:417-736-9332
Practice Address - Fax:417-736-9391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-22
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO031463314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO108297805Medicaid
MO17764866OtherSTATE ID
MO17764866OtherSTATE ID