Provider Demographics
NPI:1598751943
Name:N & R OF FULTON, INC.
Entity Type:Organization
Organization Name:N & R OF FULTON, INC.
Other - Org Name:FULTON 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:573-481-9625
Mailing Address - Street 1:1510 N BLUFF ST
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:MO
Mailing Address - Zip Code:65251-2352
Mailing Address - Country:US
Mailing Address - Phone:573-642-0202
Mailing Address - Fax:573-642-6207
Practice Address - Street 1:1510 N BLUFF ST
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:MO
Practice Address - Zip Code:65251-2352
Practice Address - Country:US
Practice Address - Phone:573-642-0202
Practice Address - Fax:573-642-6207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-21
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO029715314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO16773641OtherSTATE ID
MO101776805Medicaid
MO265663Medicare Oscar/Certification