Provider Demographics
NPI:1932481587
Name:PARKVIEW HEALTHCARE MANAGEMENT
Entity Type:Organization
Organization Name:PARKVIEW HEALTHCARE MANAGEMENT
Other - Org Name:PARKVIEW MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JUDAH
Authorized Official - Middle Name:
Authorized Official - Last Name:BIENSTOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-917-1297
Mailing Address - Street 1:516 13TH ST
Mailing Address - Street 2:
Mailing Address - City:WELLMAN
Mailing Address - State:IA
Mailing Address - Zip Code:52356-9232
Mailing Address - Country:US
Mailing Address - Phone:319-646-2911
Mailing Address - Fax:319-646-2941
Practice Address - Street 1:516 13TH ST
Practice Address - Street 2:
Practice Address - City:WELLMAN
Practice Address - State:IA
Practice Address - Zip Code:52356-9232
Practice Address - Country:US
Practice Address - Phone:319-646-2911
Practice Address - Fax:319-646-2941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-09
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAN/A310400000X
IAI-820314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA165234Medicare Oscar/Certification