Basic Information
| Provider Information | |||||||||
| NPI: | 1033105226 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | N & R OF SENATH NORTH, INC. | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | SENATH NURSING HOME | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 940 | ||||||||
| Address2: | |||||||||
| City: | SENATH | ||||||||
| State: | MO | ||||||||
| PostalCode: | 638760940 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5737382627 | ||||||||
| FaxNumber: | 5737382670 | ||||||||
| Practice Location | |||||||||
| Address1: | HIGHWAY 412 S | ||||||||
| Address2: | |||||||||
| City: | SENATH | ||||||||
| State: | MO | ||||||||
| PostalCode: | 63876 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5737382627 | ||||||||
| FaxNumber: | 5737382670 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/22/2005 | ||||||||
| LastUpdateDate: | 04/25/2008 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | HUDSPETH | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | COO CFO | ||||||||
| AuthorizedOfficialTelephone: | 5733920316 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 031497 | MO | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 101495406 | 05 | MO | MEDICAID | 16878167 | 01 | MO | STATE ID | OTHER |