Provider Demographics
NPI:1558357814
Name:N & R OF HOLLISTER, LLC
Entity Type:Organization
Organization Name:N & R OF HOLLISTER, LLC
Other - Org Name:POINT LOOKOUT NURSING & REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:C
Authorized Official - Last Name:LINCOLN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-746-7100
Mailing Address - Street 1:11103 HISTORIC HIGHWAY 165
Mailing Address - Street 2:
Mailing Address - City:HOLLISTER
Mailing Address - State:MO
Mailing Address - Zip Code:65672-6239
Mailing Address - Country:US
Mailing Address - Phone:417-334-4105
Mailing Address - Fax:417-334-1698
Practice Address - Street 1:11103 HISTORIC HIGHWAY 165
Practice Address - Street 2:
Practice Address - City:HOLLISTER
Practice Address - State:MO
Practice Address - Zip Code:65672-6239
Practice Address - Country:US
Practice Address - Phone:417-334-4105
Practice Address - Fax:417-334-1698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-22
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO031665314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO18476791OtherSTATE ID
MO102307204Medicaid
MO265411Medicare Oscar/Certification