Provider Demographics
NPI:1578905071
Name:SHELTONS RCF LLC
Entity Type:Organization
Organization Name:SHELTONS RCF LLC
Other - Org Name:SHELTON'S RCF
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:COTY
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:SHELTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-223-2032
Mailing Address - Street 1:1610 BARNES ST
Mailing Address - Street 2:
Mailing Address - City:PIEDMONT
Mailing Address - State:MO
Mailing Address - Zip Code:63957-1003
Mailing Address - Country:US
Mailing Address - Phone:573-223-2032
Mailing Address - Fax:573-223-2346
Practice Address - Street 1:1610 BARNES ST
Practice Address - Street 2:
Practice Address - City:PIEDMONT
Practice Address - State:MO
Practice Address - Zip Code:63957-1003
Practice Address - Country:US
Practice Address - Phone:573-223-2032
Practice Address - Fax:573-223-2346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-24
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO041071310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility