Basic Information
| Provider Information | |||||||||
| NPI: | 1942546627 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | AMERICARE AT VICTORIAN MANOR OF HERMANN, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | VICTORIAN PLACE OF HERMANN RESIDENTIAL CARE BY AMERICARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2120 VILLAGE LN | ||||||||
| Address2: | |||||||||
| City: | HERMANN | ||||||||
| State: | MO | ||||||||
| PostalCode: | 650411600 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 2120 VILLAGE LN | ||||||||
| Address2: | |||||||||
| City: | HERMANN | ||||||||
| State: | MO | ||||||||
| PostalCode: | 650411600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5734865060 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/27/2012 | ||||||||
| LastUpdateDate: | 12/27/2012 | ||||||||
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| AuthorizedOfficialLastName: | REIKER | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5734711113 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | Y | Nursing & Custodial Care Facilities | Assisted Living Facility |
No ID Information.