Provider Demographics
NPI:1033380670
Name:VICTORIAN MANOR OF UNION
Entity Type:Organization
Organization Name:VICTORIAN MANOR OF UNION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:L
Authorized Official - Last Name:QUICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-437-2103
Mailing Address - Street 1:1015 SPRINGFIELD RD
Mailing Address - Street 2:
Mailing Address - City:OWENSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65066
Mailing Address - Country:US
Mailing Address - Phone:573-437-2103
Mailing Address - Fax:573-437-2219
Practice Address - Street 1:1320 W MAIN ST
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:MO
Practice Address - Zip Code:63084-1084
Practice Address - Country:US
Practice Address - Phone:636-584-0085
Practice Address - Fax:636-584-0433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-21
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO24408 D261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service