Provider Demographics
NPI:1861910440
Name:MAKLER, ROBERT JOSEPH (OWNER OF RCF)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:JOSEPH
Last Name:MAKLER
Suffix:
Gender:M
Credentials:OWNER OF RCF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 WALMART DR STE 108
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63640-3315
Mailing Address - Country:US
Mailing Address - Phone:479-756-8601
Mailing Address - Fax:573-246-6052
Practice Address - Street 1:3381 1ST ST
Practice Address - Street 2:
Practice Address - City:DOE RUN
Practice Address - State:MO
Practice Address - Zip Code:63637-3155
Practice Address - Country:US
Practice Address - Phone:573-760-8601
Practice Address - Fax:573-246-6052
Is Sole Proprietor?:No
Enumeration Date:2017-09-05
Last Update Date:2017-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOEL-0996-INIT376G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376G00000XNursing Service Related ProvidersNursing Home Administrator
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO82-1282578Medicaid