Organization
N & R OF KIMBERLING CITY LLC
Active
Other names
TABLEROCK HEALTHCARE
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES C LINCOLN (MEMBER)
(573) 481-9625
Entity
Organization
Contact information
Practice address
276 FOUNTAIN LN, KIMBERLING CITY, MO 65686-9356
(417) 739-2481
(417) 739-4412
Mailing address
276 FOUNTAIN LN, KIMBERLING CITY, MO 65686-9356
(417) 739-2481
(417) 739-4412
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102120607
—
MO
Enumeration date
01/05/2011
Last updated
01/05/2011
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