Provider Demographics
NPI:1316933369
Name:N & R OF MONTICELLO, INC.
Entity type:Organization
Organization Name:N & R OF MONTICELLO, INC.
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:573-481-9625
Mailing Address - Street 1:PO BOX 740
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MO
Mailing Address - Zip Code:63755-0740
Mailing Address - Country:US
Mailing Address - Phone:573-243-8989
Mailing Address - Fax:573-243-6836
Practice Address - Street 1:1115 K LAND DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MO
Practice Address - Zip Code:63755-2588
Practice Address - Country:US
Practice Address - Phone:573-243-8989
Practice Address - Fax:573-243-6836
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:N & R OF MONTICELLO, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-09-26
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO031405320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO16950101OtherSTATE ID