Provider Demographics
NPI:1235536301
Name:N & R OF HERMITAGE LLC
Entity Type:Organization
Organization Name:N & R OF HERMITAGE LLC
Other - Org Name:HERMITAGE NURSING & REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
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:HWY 54 AND 1ST ST.
Mailing Address - Street 2:P.O. BOX 325
Mailing Address - City:HERMITAGE
Mailing Address - State:MO
Mailing Address - Zip Code:65668
Mailing Address - Country:US
Mailing Address - Phone:417-745-2111
Mailing Address - Fax:417-745-2211
Practice Address - Street 1:HWY 54 AND 1ST ST.
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:MO
Practice Address - Zip Code:65668
Practice Address - Country:US
Practice Address - Phone:417-745-2111
Practice Address - Fax:417-745-2211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-04
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO041318314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO101975308Medicaid
MO265239Medicare Oscar/Certification