NPIMap

Organization Active NPI

N & R of Maryville LLC

  • Skilled Nursing Facility
  • Maryville, MO
National Provider Identifier
1508311747
Registry record updated Nov 29, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
043410 Issued in MO
Legal business name
N & R OF MARYVILLE LLC
Practice address
524 N Laura St
Maryville, MO 64468-1955
Phone
(660) 582-7447
Fax
(660) 582-4027
NPI assigned
Aug 17, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 29, 2016

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

Authorized official

Name
Mathias P Dasal
Title
Member
Phone
(573) 481-9625

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 043410 MO Primary
Physical Disabilities Residential Treatment Facility 320700000X 042102 MO

Addresses

Primary practice location

524 N Laura St
Maryville, MO 64468-1955

Mailing address

524 N Laura St
Maryville, MO 64468-1955
Phone (660) 582-7447

Other identifiers 1

IdentifierTypeStateIssuer
101490902MedicaidMO

Other names 1

  • MARYVILLE LIVING CENTER Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20161130002505 MO Part A Provider - Skilled Nursing Facility 8820378243 Practice locations: Maryville, MO

Skilled nursing facility certification: CCN 265354

Legal name
N & R OF MARYVILLE LLC
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Mar 1, 1989
Last certification
Jun 12, 2024
Beds
105
Ownership / control type
Corporation
Organization structure
LLCProprietary
Incorporated
Sep 1, 2016 in MO
Enrollment address
524 N Laura St
Maryville, MO 64468-1955
Nursing home name
MARYVILLE REHABILITATION & HEALTH CARE CENTER
Affiliated entity
JAMES & JUDY LINCOLN

Care Compare: Nursing home

Medicare Care Compare
Listed as
Maryville Rehabilitation & Health Care CenterCCN 265354
Overall star rating
1 of 5
Health inspections
2 of 5
Staffing
1 of 5
Quality measures
1 of 5
Type
Medicare and Medicaid
Ownership
For profit - Corporation
Certified
Mar 1, 1989
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
10543.1 residents per day on average
Chain
James & Judy Lincoln56 facilities in the chain
Abuse citation
Cited for abuse (Care Compare abuse icon)
Penalties (3 years)
3Fines totaling $86,912

Processed by Care Compare on Aug 1, 2026.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
26D0689959N & R of Maryville, LLC524 N Laura Street, Maryville, MO 64468Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory

Locations

524 N Laura St
Maryville, MO 64468
Phone (660) 582-7447

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
LTC Management Services LLC Organization, Sikeston, MO Management services company Operational/Managerial Control Sep 1, 2016 100%
James C Lincoln Individual 5% Or Greater Direct Ownership Interest Sep 1, 2016 50%
Operational/Managerial Control Sep 1, 2016
Judy L Lincoln Individual 5% Or Greater Direct Ownership Interest Sep 1, 2016 50%

Facilities with the same owner 36

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 36

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Affiliated clinicians 3

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

NPI Registry JSON

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

{
    "created_epoch": "1471392000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1480377600000",
    "number": "1508311747",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "524 N LAURA ST",
            "city": "MARYVILLE",
            "state": "MO",
            "postal_code": "644681955",
            "telephone_number": "660-582-7447",
            "fax_number": "660-582-4027"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "524 N LAURA ST",
            "city": "MARYVILLE",
            "state": "MO",
            "postal_code": "644681955",
            "telephone_number": "660-582-7447",
            "fax_number": "660-582-4027"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "N & R OF MARYVILLE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-17",
        "last_updated": "2016-11-29",
        "status": "A",
        "authorized_official_last_name": "DASAL",
        "authorized_official_first_name": "MATHIAS",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "573-481-9625"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MO",
            "license": "043410",
            "primary": true
        },
        {
            "code": "320700000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Physical Disabilities",
            "state": "MO",
            "license": "042102",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "101490902",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MARYVILLE LIVING CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Maryville, MO

Sources for this page

Verify at the official NPI Registry.