N & R of Fredericktown, Inc.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

029883 Issued in MO

Legal business name

N & R OF FREDERICKTOWN, INC.

Doing business as

ClaRu DeVille Nursing Center

Practice address

105 Spruce St
Fredericktown, MO 63645-1002

Phone

(573) 783-3993

Fax

(573) 783-5092

NPI assigned

Sep 21, 2005

Last updated

Aug 13, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Carla Hedrick

Title

Cfo

Phone

(573) 481-9625

Specialties & licenses 1

Addresses

Other names 1

• ClaRu DeVille Nursing Center Doing business as

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1366438731. Details of each certification follow.

• CCN 265514 Skilled nursing facility · Active · Details

Skilled nursing facility certification: CCN 265514

Legal name

N & R OF FREDERICKTOWN, INC.

Doing business as

CLARU DEVILLE NURSING CENTER

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

Nov 16, 1992

Last certification

Jan 17, 2025

Beds

90

Ownership / control type

Corporation

Multi-facility organization

HEALTH SYSTEMS

Organization structure

CorporationProprietary

Incorporated

Aug 1, 1998 in MO

Enrollment address

105 Spruce St
Fredericktown, MO 63645-1002

Nursing home name

CLARU DEVILLE NURSING CENTER

Affiliated entity

JAMES & JUDY LINCOLN

Listed as

Claru Deville Nursing CenterCCN 265514 · All quality measures

Overall star rating

3 of 5

Health inspections

2 of 5

Staffing

2 of 5

Quality measures

5 of 5

Type

Medicare and Medicaid

Ownership

For profit - Corporation

Certified

Nov 16, 1992

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

9067.5 residents per day on average

Chain

James & Judy Lincoln56 facilities in the chain

Penalties (3 years)

2Fines totaling $81,964

Processed by Care Compare on Aug 1, 2026.

All disclosed owners & managing parties 7

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Edward Burke, M.D.

  • Internal Medicine Physician
  • Fredericktown, MO
  • NPI 1306885157
  NPD (past)
• Paul S Moniz, DO

  • Family Medicine Physician
  • Farmington, MO
  • NPI 1154373017
  NPD (past)

Affiliated clinicians 2

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• Edward Burke, M.D.

  • Internal Medicine Physician
  • Fredericktown, MO
  • NPI 1306885157

  Nursing home

  Care Compare affiliation
• Buntee Co, MD

  • Psychiatry Physician
  • Fewtus, MO
  • NPI 1437210796

  Nursing home

  Care Compare affiliation

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

{
    "created_epoch": "1127260800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1755043200000",
    "number": "1366438731",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 SPRUCE ST",
            "city": "FREDERICKTOWN",
            "state": "MO",
            "postal_code": "636451002",
            "telephone_number": "573-783-3993",
            "fax_number": "573-783-5092"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 SPRUCE ST",
            "city": "FREDERICKTOWN",
            "state": "MO",
            "postal_code": "636451002",
            "telephone_number": "573-783-3993",
            "fax_number": "573-783-5092"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "N & R OF FREDERICKTOWN, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-21",
        "last_updated": "2025-08-13",
        "certification_date": "2025-08-13",
        "status": "A",
        "authorized_official_last_name": "HEDRICK",
        "authorized_official_first_name": "CARLA",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "573-481-9625"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MO",
            "license": "029883",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://199.119.81.30:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRResponse_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.1066.1",
            "affiliationName": "eSolutions Inc",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "8215 W 108th Ter",
            "city": "Overland Park",
            "state": "KS",
            "country_code": "US",
            "postal_code": "662101661",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "ClaRu DeVille Nursing Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Midwest Health Group Convenient Care, LLC (Midwest Convenient Care)
• Craig J. Millham, P.T.
• Modern Mental Health
• Sarah Pauline Mueller, PMHNP-BC
• Samantha Lee Musket, RMA
• Nra Fredericktown Missouri LLC (Fredericktown Dialysis Clinic)
• Patrick O'Hara
• Humberto Jose Olivero Lara, MD, MSPH
• Ozark Manor Inc
• Rhonda Ellen Palmer, MSW,LCSW

• Skilled Nursing Facility in Fredericktown, MO
• Providers in Fredericktown, 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 Aug 13, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.