Provider Demographics
NPI:1679303275
Name:BLEAURIDGE NURSING AND REHAB LLC
Entity type:Organization
Organization Name:BLEAURIDGE NURSING AND REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHAFIQ
Authorized Official - Middle Name:
Authorized Official - Last Name:MALIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-335-3044
Mailing Address - Street 1:2215 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63701-4403
Mailing Address - Country:US
Mailing Address - Phone:573-335-3044
Mailing Address - Fax:573-335-6724
Practice Address - Street 1:1003 S CEDAR ST
Practice Address - Street 2:
Practice Address - City:BELTON
Practice Address - State:MO
Practice Address - Zip Code:64012-4403
Practice Address - Country:US
Practice Address - Phone:816-331-0781
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-07
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility