Provider Demographics
NPI:1124573951
Name:N & R OF CLINTON LLC
Entity Type:Organization
Organization Name:N & R OF CLINTON LLC
Other - Org Name:WESTWOOD 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 1:1801 N GAINES DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MO
Mailing Address - Zip Code:64735-1127
Mailing Address - Country:US
Mailing Address - Phone:660-885-8196
Mailing Address - Fax:660-885-6081
Practice Address - Street 1:1801 N GAINES DR
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MO
Practice Address - Zip Code:64735-1127
Practice Address - Country:US
Practice Address - Phone:660-885-8196
Practice Address - Fax:660-885-6081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-22
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO042951314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO101457901Medicaid
MO101457901Medicaid