Organization
PREMIER RESIDENTIAL CARE LLC
Active
Other names
Pine Lodge Residential Care
Organization subpart
No
Provider details
NPI number
Authorized official
PAULINE S GUNTER (OWNER/OPERATOR)
(417) 345-0310
Entity
Organization
Contact information
Practice address
967 NORTH MAPLE, BUFFALO, MO 65622
(417) 345-0310
Mailing address
967 NORTH MAPLE, BUFFALO, MO 65622
(417) 345-0310
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
035613
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1891979126
—
MO
Enumeration date
08/19/2008
Last updated
08/19/2008
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