Basic Information
| Provider Information | |||||||||
| NPI: | 1932487832 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BELLEVIEW VALLEY SKILLED NURSING CARE, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 23144 HIGHWAY 32 | ||||||||
| Address2: | |||||||||
| City: | BELLEVIEW | ||||||||
| State: | MO | ||||||||
| PostalCode: | 636236346 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5736975311 | ||||||||
| FaxNumber: | 5736975389 | ||||||||
| Practice Location | |||||||||
| Address1: | 23144 HIGHWAY 32 | ||||||||
| Address2: | |||||||||
| City: | BELLEVIEW | ||||||||
| State: | MO | ||||||||
| PostalCode: | 636236346 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5736975311 | ||||||||
| FaxNumber: | 5736975389 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2011 | ||||||||
| LastUpdateDate: | 08/22/2016 | ||||||||
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| AuthorizedOfficialLastName: | ANDERSON | ||||||||
| AuthorizedOfficialFirstName: | PATRICIA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 5735461616 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | MO | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 101479707 | 05 | MO | MEDICAID |