Provider Demographics
NPI:1861488116
Name:N & R OF CALIFORNIA WEST, LLC
Entity Type:Organization
Organization Name:N & R OF CALIFORNIA WEST, LLC
Other - Org Name:MONITEAU CARE CENTER
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:573-746-7100
Mailing Address - Street 1:200 S GERHART RD
Mailing Address - Street 2:
Mailing Address - City:CALIFORNIA
Mailing Address - State:MO
Mailing Address - Zip Code:65018-2433
Mailing Address - Country:US
Mailing Address - Phone:573-796-3822
Mailing Address - Fax:573-796-2715
Practice Address - Street 1:200 S GERHART RD
Practice Address - Street 2:
Practice Address - City:CALIFORNIA
Practice Address - State:MO
Practice Address - Zip Code:65018-2433
Practice Address - Country:US
Practice Address - Phone:573-796-3822
Practice Address - Fax:573-796-2715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-22
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO031405314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO18014208OtherSTATE ID
MO108240706Medicaid
MO18014208OtherSTATE ID