Provider Demographics
NPI:1285682633
Name:N & R OF MAYSVILLE, LLC
Entity Type:Organization
Organization Name:N & R OF MAYSVILLE, LLC
Other - Org Name:SUNSET HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:HUDSPETH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-392-0316
Mailing Address - Street 1:1201 S POLK ST
Mailing Address - Street 2:
Mailing Address - City:MAYSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64469-4028
Mailing Address - Country:US
Mailing Address - Phone:816-449-2158
Mailing Address - Fax:816-449-5216
Practice Address - Street 1:1201 S POLK ST
Practice Address - Street 2:
Practice Address - City:MAYSVILLE
Practice Address - State:MO
Practice Address - Zip Code:64469-4028
Practice Address - Country:US
Practice Address - Phone:816-449-2158
Practice Address - Fax:816-449-5216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO032294314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO265745Medicare ID - Type UnspecifiedPROVIDER NUMBER