Provider Demographics
NPI:1477549822
Name:N & R OF CAMDENTON, INC.
Entity Type:Organization
Organization Name:N & R OF CAMDENTON, INC.
Other - Org Name:CAMDENTON WINDSOR ESTATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:C
Authorized Official - Last Name:LINCOLN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-481-9625
Mailing Address - Street 1:2042 N BUSINESS ROUTE 5
Mailing Address - Street 2:
Mailing Address - City:CAMDENTON
Mailing Address - State:MO
Mailing Address - Zip Code:65020-2611
Mailing Address - Country:US
Mailing Address - Phone:573-346-5654
Mailing Address - Fax:573-346-7472
Practice Address - Street 1:2042 N BUSINESS ROUTE 5
Practice Address - Street 2:
Practice Address - City:CAMDENTON
Practice Address - State:MO
Practice Address - Zip Code:65020-2611
Practice Address - Country:US
Practice Address - Phone:573-346-5654
Practice Address - Fax:573-346-7472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-21
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO031410314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO17171989OtherSTATE ID
MO101481406Medicaid
MO265091Medicare Oscar/Certification