Provider Demographics
NPI:1932487832
Name:BELLEVIEW VALLEY SKILLED NURSING CARE, LLC
Entity Type:Organization
Organization Name:BELLEVIEW VALLEY SKILLED NURSING CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-546-1616
Mailing Address - Street 1:23144 HIGHWAY 32
Mailing Address - Street 2:
Mailing Address - City:BELLEVIEW
Mailing Address - State:MO
Mailing Address - Zip Code:63623-6346
Mailing Address - Country:US
Mailing Address - Phone:573-697-5311
Mailing Address - Fax:573-697-5389
Practice Address - Street 1:23144 HIGHWAY 32
Practice Address - Street 2:
Practice Address - City:BELLEVIEW
Practice Address - State:MO
Practice Address - Zip Code:63623-6346
Practice Address - Country:US
Practice Address - Phone:573-697-5311
Practice Address - Fax:573-697-5389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-26
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO101479707Medicaid
MO265258Medicare Oscar/Certification