Provider Demographics
NPI:1114027208
Name:EASTVIEW MANOR, INC.
Entity Type:Organization
Organization Name:EASTVIEW MANOR, INC.
Other - Org Name:EASTVIEW MANOR CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:ASHWIN
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNDOO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-543-3800
Mailing Address - Street 1:1869 CRAIG PARK CT
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63146-4122
Mailing Address - Country:US
Mailing Address - Phone:314-543-3800
Mailing Address - Fax:314-543-3880
Practice Address - Street 1:1622 E 28TH STREET
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:MO
Practice Address - Zip Code:64683-1104
Practice Address - Country:US
Practice Address - Phone:660-359-2251
Practice Address - Fax:660-359-6667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO031838314000000X
MO041309314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO265730Medicare PIN