Provider Demographics
NPI:1851308969
Name:PARKVIEW MANOR, INC.
Entity Type:Organization
Organization Name:PARKVIEW MANOR, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:CONWAY
Authorized Official - Last Name:NIEDERT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:319-345-6811
Mailing Address - Street 1:1009 3RD STREET
Mailing Address - Street 2:
Mailing Address - City:REINBECK
Mailing Address - State:IA
Mailing Address - Zip Code:50669-1157
Mailing Address - Country:US
Mailing Address - Phone:319-345-6811
Mailing Address - Fax:319-345-2624
Practice Address - Street 1:1009 3RD STREET
Practice Address - Street 2:
Practice Address - City:REINBECK
Practice Address - State:IA
Practice Address - Zip Code:50669-1157
Practice Address - Country:US
Practice Address - Phone:319-345-6811
Practice Address - Fax:319-345-2624
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-02
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA165522313M00000X
IA0386314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0490847Medicaid
IA0803148Medicaid
IA165522Medicare Oscar/Certification