Provider Demographics
NPI:1538155742
Name:N & R OF TIPTON, LLC
Entity type:Organization
Organization Name:N & R OF TIPTON, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
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 1:601 W MORGAN ST
Mailing Address - Street 2:
Mailing Address - City:TIPTON
Mailing Address - State:MO
Mailing Address - Zip Code:65081-8214
Mailing Address - Country:US
Mailing Address - Phone:660-433-5574
Mailing Address - Fax:660-433-2622
Practice Address - Street 1:601 W MORGAN ST
Practice Address - Street 2:
Practice Address - City:TIPTON
Practice Address - State:MO
Practice Address - Zip Code:65081-8214
Practice Address - Country:US
Practice Address - Phone:660-433-5574
Practice Address - Fax:660-433-2622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-22
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO030322314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO18770037OtherSTATE ID
MO101497105Medicaid
MO265748Medicare Oscar/Certification