Organization
PINE VIEW MANOR, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JERRY B DOERHOFF (ADMINISTRATOR)
(660) 783-2118
Entity
Organization
Contact information
Practice address
307 N PINEVIEW STREET, STANBERRY, MO 64489-1509
(660) 783-2118
(660) 783-2691
Mailing address
307 N PINEVIEW STREET, STANBERRY, MO 64489-1509
(660) 783-2118
(660) 783-2691
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
031426
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101493302
—
MO
Enumeration date
08/10/2005
Last updated
11/15/2011
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