Provider Demographics
NPI:1922007277
Name:R. DEVELOPMENT, INC
Entity Type:Organization
Organization Name:R. DEVELOPMENT, INC
Other - Org Name:AVALON GARDEN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:S
Authorized Official - Last Name:HASSAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:314-752-2022
Mailing Address - Street 1:4359 TAFT AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63116-1533
Mailing Address - Country:US
Mailing Address - Phone:314-752-2022
Mailing Address - Fax:314-752-7679
Practice Address - Street 1:4359 TAFT AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63116-1533
Practice Address - Country:US
Practice Address - Phone:314-752-2022
Practice Address - Fax:314-752-7679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO030570314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO26A449Medicare ID - Type Unspecified