Provider Demographics
NPI:1306840368
Name:PARKVIEW MANOR NURSING HOME
Entity Type:Organization
Organization Name:PARKVIEW MANOR NURSING HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:WERNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-967-2482
Mailing Address - Street 1:308 SHERMAN AVENUE
Mailing Address - Street 2:
Mailing Address - City:ELLSWORTH
Mailing Address - State:MN
Mailing Address - Zip Code:56129-1016
Mailing Address - Country:US
Mailing Address - Phone:507-967-2482
Mailing Address - Fax:507-967-2141
Practice Address - Street 1:308 W SHERMAN AVE
Practice Address - Street 2:
Practice Address - City:ELLSWORTH
Practice Address - State:MN
Practice Address - Zip Code:56129-1016
Practice Address - Country:US
Practice Address - Phone:507-967-2482
Practice Address - Fax:507-967-2141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN327175314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN24-5553Medicare ID - Type Unspecified