Provider Demographics
NPI:1477199180
Name:SCENIC VIEW LLC
Entity Type:Organization
Organization Name:SCENIC VIEW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:CRAWFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-631-3552
Mailing Address - Street 1:4217 SCENIC VIEW DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63640-7846
Mailing Address - Country:US
Mailing Address - Phone:583-631-3552
Mailing Address - Fax:
Practice Address - Street 1:101 S KNOB ST
Practice Address - Street 2:
Practice Address - City:IRONTON
Practice Address - State:MO
Practice Address - Zip Code:63650-1501
Practice Address - Country:US
Practice Address - Phone:573-546-3080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-18
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility