Organization
PEACEFUL PINES RESIDENTIAL CARE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY MENCKOWSKI (ADMINISTRATOR)
(573) 714-2838
Entity
Organization
Contact information
Practice address
614 COUNTY ROAD 466, POPLAR BLUFF, MO 63901-2964
(573) 778-0497
Mailing address
614 COUNTY ROAD 466, POPLAR BLUFF, MO 63901-2964
(573) 778-0497
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
032744
MO
Other
Enumeration date
09/01/2006
Last updated
08/22/2020
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