Provider Demographics
NPI:1851091656
Name:WESTERN MISSOURI NURSING AND REHAB LLC
Entity Type:Organization
Organization Name:WESTERN MISSOURI NURSING AND REHAB LLC
Other - Org Name:LUTHERAN NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHAFIQ
Authorized Official - Middle Name:
Authorized Official - Last Name:MALIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-335-3044
Mailing Address - Street 1:2215 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63701-4403
Mailing Address - Country:US
Mailing Address - Phone:573-335-3044
Mailing Address - Fax:573-335-6724
Practice Address - Street 1:202 S WEST ST
Practice Address - Street 2:
Practice Address - City:CONCORDIA
Practice Address - State:MO
Practice Address - Zip Code:64020-9643
Practice Address - Country:US
Practice Address - Phone:660-463-2267
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-09
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility