Provider Demographics
NPI:1376098616
Name:MALDEN N & R LLC
Entity Type:Organization
Organization Name:MALDEN N & R LLC
Other - Org Name:RIDGEVIEW LIVING COMMUNITY
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 1:500 BARRETT DR
Mailing Address - Street 2:
Mailing Address - City:MALDEN
Mailing Address - State:MO
Mailing Address - Zip Code:63863-1204
Mailing Address - Country:US
Mailing Address - Phone:573-276-3843
Mailing Address - Fax:573-276-3845
Practice Address - Street 1:500 BARRETT DR
Practice Address - Street 2:
Practice Address - City:MALDEN
Practice Address - State:MO
Practice Address - Zip Code:63863-1204
Practice Address - Country:US
Practice Address - Phone:573-276-3843
Practice Address - Fax:573-276-3845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-16
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO043683314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO101457604Medicaid
CA265384Medicare Oscar/Certification