Provider Demographics
NPI:1639165020
Name:N & R OF DEXTER, INC.
Entity Type:Organization
Organization Name:N & R OF DEXTER, INC.
Other - Org Name:CROWLEY RIDGE CARE CENTER
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 1:1204 N OUTER RD
Mailing Address - Street 2:
Mailing Address - City:DEXTER
Mailing Address - State:MO
Mailing Address - Zip Code:63841-8684
Mailing Address - Country:US
Mailing Address - Phone:573-624-5557
Mailing Address - Fax:573-624-5558
Practice Address - Street 1:1204 N OUTER RD
Practice Address - Street 2:
Practice Address - City:DEXTER
Practice Address - State:MO
Practice Address - Zip Code:63841-8684
Practice Address - Country:US
Practice Address - Phone:573-624-5557
Practice Address - Fax:573-624-5558
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
MO030780314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO16878060OtherSTATE ID
MO16878060OtherSTATE ID