Provider Demographics
NPI:1508852963
Name:N & R OF CEDAR HILL
Entity Type:Organization
Organization Name:N & R OF CEDAR HILL
Other - Org Name:CEDAR HILL MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO CFO
Authorized Official - Prefix:
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 1:6400 THE CEDARS CT
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:MO
Mailing Address - Zip Code:63016-2220
Mailing Address - Country:US
Mailing Address - Phone:636-274-1777
Mailing Address - Fax:636-274-4041
Practice Address - Street 1:6400 THE CEDARS CT
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:MO
Practice Address - Zip Code:63016-2220
Practice Address - Country:US
Practice Address - Phone:636-274-1777
Practice Address - Fax:636-274-4041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO031642314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1876993OtherSTATE ID
MO1876993OtherSTATE ID