Organization
CITY OF ADRIAN - ADRIAN MANOR HEALTH AND REHAB
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DOUGLAS G FREDRICKSON (ADMINISTRATOR)
(816) 297-2107
Entity
Organization
Contact information
Practice address
402 W 1ST ST, ADRIAN, MO 64720-9998
(816) 297-2107
(816) 297-4321
Mailing address
402 W 1ST ST, ADRIAN, MO 64720-9998
(816) 297-2107
(816) 297-4321
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
030454
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101478907
—
MO
Enumeration date
06/22/2006
Last updated
01/13/2012
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