Basic Information
| Provider Information | |||||||||
| NPI: | 1306394077 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MSNRC OPS, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | MAGNOLIA SQUARE NURSING AND REHAB | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1502 W EDGEWOOD ST | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MO | ||||||||
| PostalCode: | 658073567 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4178777545 | ||||||||
| FaxNumber: | 4178777551 | ||||||||
| Practice Location | |||||||||
| Address1: | 1502 W EDGEWOOD ST | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MO | ||||||||
| PostalCode: | 658073567 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4178777545 | ||||||||
| FaxNumber: | 4178777551 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/12/2016 | ||||||||
| LastUpdateDate: | 12/28/2016 | ||||||||
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| AuthorizedOfficialLastName: | ADAMS | ||||||||
| AuthorizedOfficialFirstName: | BRANDON | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5019320050 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | RHC OPERATIONS, INC. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 101491405 | 05 | MO | MEDICAID | 044662 | 01 | MO | FACILITY LICENSE | OTHER |