Provider Demographics
NPI:1891739033
Name:SHEPHERD'S VIEW, INC.
Entity Type:Organization
Organization Name:SHEPHERD'S VIEW, INC.
Other - Org Name:SHEPHERD'S VIEW ASSISTED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:BECKIE
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:COMBS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-778-7959
Mailing Address - Street 1:100 SHEPHERDS LANE
Mailing Address - Street 2:PO BOX 429
Mailing Address - City:ALTON
Mailing Address - State:MO
Mailing Address - Zip Code:65606
Mailing Address - Country:US
Mailing Address - Phone:417-778-7959
Mailing Address - Fax:417-778-1849
Practice Address - Street 1:100 SHEPHERDS LANE
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:MO
Practice Address - Zip Code:65606
Practice Address - Country:US
Practice Address - Phone:417-778-7959
Practice Address - Fax:417-778-1849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-16
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO030781261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO265179200Medicaid