Provider Demographics
NPI:1427216555
Name:BOONVILLE RESIDENTIAL LLC
Entity Type:Organization
Organization Name:BOONVILLE RESIDENTIAL LLC
Other - Org Name:HARTMANN VILLAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:REIKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-882-9933
Mailing Address - Street 1:600 RANKIN MILL LANE
Mailing Address - Street 2:
Mailing Address - City:BOONVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65233
Mailing Address - Country:US
Mailing Address - Phone:660-882-9933
Mailing Address - Fax:
Practice Address - Street 1:600 RANKIN MILL LANE
Practice Address - Street 2:
Practice Address - City:BOONVILLE
Practice Address - State:MO
Practice Address - Zip Code:65233
Practice Address - Country:US
Practice Address - Phone:660-882-9933
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-27
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility