Rolla Manor, Inc.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

017746 Issued in MO

Legal business name

ROLLA MANOR, INC.

Doing business as

Rolla Manor Care Center

Practice address

1800 White Columns Drive
Rolla, MO 65401

Phone

(573) 364-7766

Fax

(573) 364-4036

NPI assigned

Sep 13, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Benjamin C. Scheulen

Title

Ceo

Phone

(573) 556-6240

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Rolla Manor Care Center Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158105600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1479859200000",
    "number": "1316042898",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1800 WHITE COLUMNS DRIVE",
            "city": "ROLLA",
            "state": "MO",
            "postal_code": "65401",
            "telephone_number": "573-364-7766",
            "fax_number": "573-364-1593"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1800 WHITE COLUMNS DRIVE",
            "city": "ROLLA",
            "state": "MO",
            "postal_code": "65401",
            "telephone_number": "573-364-7766",
            "fax_number": "573-364-4036"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROLLA MANOR, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-13",
        "last_updated": "2016-11-23",
        "status": "A",
        "authorized_official_last_name": "SCHEULEN",
        "authorized_official_first_name": "BENJAMIN",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "573-556-6240"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MO",
            "license": "017746",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "102122009",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Rolla Manor Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Skilled Nursing Facility in Rolla, MO
• Providers in Rolla, MO by specialty
• Skilled Nursing Facility in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.