Provider Demographics
NPI:1821334509
Name:AMERICARE AT VICTORIAN MANOR OF VIENNA, LLC
Entity Type:Organization
Organization Name:AMERICARE AT VICTORIAN MANOR OF VIENNA, LLC
Other - Org Name:VICTORIAN PLACE OF VIENNA RESIDENTIAL CARE BY AMERICARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:REIKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-471-1113
Mailing Address - Street 1:112 PARKWAY
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:MO
Mailing Address - Zip Code:65582-8003
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:112 PARKWAY
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:MO
Practice Address - Zip Code:65582-8003
Practice Address - Country:US
Practice Address - Phone:573-422-3230
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-27
Last Update Date:2012-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility