Provider Demographics
NPI:1235161233
Name:SANDRETTO HILLS NURSING CENTER 2
Entity Type:Organization
Organization Name:SANDRETTO HILLS NURSING CENTER 2
Other - Org Name:MOUNTAIN VIEW MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:B
Authorized Official - Last Name:BEDELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-471-1276
Mailing Address - Street 1:PO BOX 1210
Mailing Address - Street 2:
Mailing Address - City:SIKESTON
Mailing Address - State:MO
Mailing Address - Zip Code:63801-1210
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1045 SANDRETTO DR
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-3717
Practice Address - Country:US
Practice Address - Phone:928-778-4837
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2017-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZNCI-358314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ041707Medicaid
AZ041707Medicaid