Provider Demographics
NPI:1538108469
Name:NORTHVIEW VILLAGE, INC.
Entity Type:Organization
Organization Name:NORTHVIEW VILLAGE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAKHLOUF
Authorized Official - Middle Name:
Authorized Official - Last Name:SUISSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-361-1300
Mailing Address - Street 1:2415 N KINGSHIGHWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63113-1109
Mailing Address - Country:US
Mailing Address - Phone:314-361-1300
Mailing Address - Fax:314-361-1374
Practice Address - Street 1:2415 N KINGSHIGHWAY BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63113-1109
Practice Address - Country:US
Practice Address - Phone:314-361-1300
Practice Address - Fax:314-361-1374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO265524314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO101776706Medicaid
MO265524Medicare Oscar/Certification
MO0928280001Medicare NSC