Organization
PINE VIEW ISL
Active
Organization
PINE VIEW ISL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SANDRA KAY SMITH (QMRP)
(417) 932-4557
Entity
Organization
Contact information
Practice address
4281 HIGHWAY 17, SUMMERSVILLE, MO 65571-8204
(417) 932-4557
(417) 932-4558
Mailing address
305 HORAK DR, WILLOW SPRINGS, MO 65793-3576
(417) 932-4557
(417) 932-4558
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
03/21/2007
Last updated
08/22/2020
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