Organization
PACIFIC MANOR LLC
Active
Other names
PACIFIC MANOR
Organization subpart
No
Provider details
NPI number
Authorized official
CARLA HEDRICK CFO (CFO)
(573) 481-9625
Entity
Organization
Contact information
Practice address
105 S 6TH ST, PACIFIC, MO 63069-1328
(636) 271-4222
(636) 257-8131
Mailing address
1220 N MAIN ST, SIKESTON, MO 63801-4827
(573) 481-9625
(573) 472-0098
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102343001
—
MO
Enumeration date
06/10/2019
Last updated
09/15/2025
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