Provider Demographics
NPI:1104254218
Name:BERTRAND NURSING & REHAB CTR LLC
Entity type:Organization
Organization Name:BERTRAND NURSING & REHAB CTR LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DON
Authorized Official - Middle Name:D
Authorized Official - Last Name:CHANCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-683-4290
Mailing Address - Street 1:603 HIGHWAY 62 W
Mailing Address - Street 2:
Mailing Address - City:BERTRAND
Mailing Address - State:MO
Mailing Address - Zip Code:63823-9738
Mailing Address - Country:US
Mailing Address - Phone:573-683-4290
Mailing Address - Fax:573-683-4304
Practice Address - Street 1:603 HIGHWAY 62 W
Practice Address - Street 2:
Practice Address - City:BERTRAND
Practice Address - State:MO
Practice Address - Zip Code:63823-9738
Practice Address - Country:US
Practice Address - Phone:573-233-4464
Practice Address - Fax:573-472-1880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-29
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
314000000X
MO041755314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO101480002Medicaid
MO265678Medicare Oscar/Certification