Provider Demographics
NPI:1821113408
Name:PINE VIEW CHRISTIAN HOME
Entity Type:Organization
Organization Name:PINE VIEW CHRISTIAN HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:QMRP
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-932-4557
Mailing Address - Street 1:305 HORAK DR
Mailing Address - Street 2:
Mailing Address - City:WILLOW SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:65793-3576
Mailing Address - Country:US
Mailing Address - Phone:417-932-4557
Mailing Address - Fax:417-932-4558
Practice Address - Street 1:4281 HIGHWAY 17
Practice Address - Street 2:
Practice Address - City:SUMMERSVILLE
Practice Address - State:MO
Practice Address - Zip Code:65571-8204
Practice Address - Country:US
Practice Address - Phone:417-932-4557
Practice Address - Fax:417-932-4558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251C00000XAgenciesDay Training, Developmentally Disabled Services
Not Answered320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Not Answered385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child