Provider Demographics
NPI:1609873652
Name:PARKVIEW HOME
Entity Type:Organization
Organization Name:PARKVIEW HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:GOERITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-938-4151
Mailing Address - Street 1:102 CSAH 9
Mailing Address - Street 2:
Mailing Address - City:BELVIEW
Mailing Address - State:MN
Mailing Address - Zip Code:56214-1102
Mailing Address - Country:US
Mailing Address - Phone:507-938-4151
Mailing Address - Fax:507-938-4110
Practice Address - Street 1:102 CSAH 9
Practice Address - Street 2:
Practice Address - City:BELVIEW
Practice Address - State:MN
Practice Address - Zip Code:56214-1102
Practice Address - Country:US
Practice Address - Phone:507-938-4151
Practice Address - Fax:507-938-4110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-06
Last Update Date:2017-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN328691314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN2248-40900Medicaid
MN2248-40900Medicaid