Basic Information
| Provider Information | |||||||||
| NPI: | 1740276963 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | N & R OF SENATH SOUTH, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | SENATH NURSING HOME SOUTH | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 958 | ||||||||
| Address2: | |||||||||
| City: | SENATH | ||||||||
| State: | MO | ||||||||
| PostalCode: | 638760958 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5737382679 | ||||||||
| FaxNumber: | 5737382670 | ||||||||
| Practice Location | |||||||||
| Address1: | HIGHWAY 412 SOUTH | ||||||||
| Address2: | |||||||||
| City: | SENATH | ||||||||
| State: | MO | ||||||||
| PostalCode: | 63876 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5737382679 | ||||||||
| FaxNumber: | 5737382670 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/22/2005 | ||||||||
| LastUpdateDate: | 01/20/2009 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | HUDSPETH | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | COO CFO | ||||||||
| AuthorizedOfficialTelephone: | 5733920316 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 313M00000X | 030092 | MO | Y | Nursing & Custodial Care Facilities | Nursing Facility/Intermediate Care Facility |
ID Information
| ID | Type | State | Issuer | Description | 16877969 | 01 | MO | STATE ID | OTHER | 102937307 | 05 | MO | MEDICAID |