Provider Demographics
NPI:1912090564
Name:N & R OF COLUMBIA, LLC
Entity Type:Organization
Organization Name:N & R OF COLUMBIA, LLC
Other - Org Name:PARKSIDE MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
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 1:1201 HUNT AVENUE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65202-1367
Mailing Address - Country:US
Mailing Address - Phone:573-449-1448
Mailing Address - Fax:573-443-2591
Practice Address - Street 1:1201 HUNT AVENUE
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65202-1367
Practice Address - Country:US
Practice Address - Phone:573-449-1448
Practice Address - Fax:573-443-2591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO034974314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
265302Medicare Oscar/Certification