Organization
N & R OF WELLSVILLE LLC
Active
Other names
GAMMA ROAD LODGE
Organization subpart
No
Provider details
NPI number
Authorized official
MATHIAS P DASAL (MEMBER)
(573) 481-9625
Entity
Organization
Contact information
Practice address
250 E LOCUST ST, WELLSVILLE, MO 63384-1422
(573) 684-2002
(573) 684-3260
Mailing address
250 E LOCUST ST, WELLSVILLE, MO 63384-1422
(573) 684-2002
(573) 684-3260
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
043606
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101456408
—
MO
Enumeration date
08/17/2016
Last updated
11/21/2016
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