Organization
N & R OF MARYVILLE LLC
Active
Other names
MARYVILLE LIVING CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
MATHIAS P DASAL (MEMBER)
(573) 481-9625
Entity
Organization
Contact information
Practice address
524 N LAURA ST, MARYVILLE, MO 64468-1955
(660) 582-7447
(660) 582-4027
Mailing address
524 N LAURA ST, MARYVILLE, MO 64468-1955
(660) 582-7447
(660) 582-4027
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
043410
MO
320700000X
Physical Disabilities Residential Treatment Facility
042102
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101490902
—
MO
Enumeration date
08/17/2016
Last updated
11/29/2016
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