Provider Demographics
NPI:1467643502
Name:VICTORIAN MANOR OF CUBA INC
Entity Type:Organization
Organization Name:VICTORIAN MANOR OF CUBA INC
Other - Org Name:VICTORIAN MANOR OF CUBA
Other - Org Type:Other Name
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:65066-1015
Mailing Address - Country:US
Mailing Address - Phone:573-437-2103
Mailing Address - Fax:573-437-2219
Practice Address - Street 1:901 HWY DD
Practice Address - Street 2:
Practice Address - City:CUBA
Practice Address - State:MO
Practice Address - Zip Code:65453-0901
Practice Address - Country:US
Practice Address - Phone:573-885-0551
Practice Address - Fax:573-885-0901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO034460310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility