Provider Demographics
NPI:1558864298
Name:ROLLA RESIDENTIAL, LLC
Entity Type:Organization
Organization Name:ROLLA RESIDENTIAL, LLC
Other - Org Name:THE ARBORS AT PARKSIDE - MEMORY CARE ASSISTED LIVING BY AMERICARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:REIKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-471-1113
Mailing Address - Street 1:214 N SCOTT ST
Mailing Address - Street 2:
Mailing Address - City:SIKESTON
Mailing Address - State:MO
Mailing Address - Zip Code:63801-4146
Mailing Address - Country:US
Mailing Address - Phone:573-471-1113
Mailing Address - Fax:
Practice Address - Street 1:1700 E 10TH ST
Practice Address - Street 2:
Practice Address - City:ROLLA
Practice Address - State:MO
Practice Address - Zip Code:65401-4600
Practice Address - Country:US
Practice Address - Phone:573-364-2602
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-08
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility