# PINE VIEW MANOR, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1386992584
- **Authorized official:** MR. JERRY B DOERHOFF (ADMINISTRATOR)
- **Authorized official phone:** (660) 783-2118

## Contact information

- **Practice address:** 307 N PINEVIEW ST, STANBERRY, MO 64489-1509
- **Practice address phone:** (660) 783-2118
- **Practice address fax:** (660) 783-2691
- **Mailing address:** 307 N PINEVIEW ST, STANBERRY, MO 64489-1509
- **Mailing address phone:** (660) 783-2118
- **Mailing address fax:** (660) 783-2691

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | 031426 | MO | Yes |

## Other

- **Enumeration date:** 08/17/2012
- **Last updated:** 08/17/2012