Basic Information
| Provider Information | |||||||||
| NPI: | 1982604450 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SPRING VIEW MANOR, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 412 S 8TH ST | ||||||||
| Address2: | |||||||||
| City: | CONWAY SPRINGS | ||||||||
| State: | KS | ||||||||
| PostalCode: | 670318252 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6204562285 | ||||||||
| FaxNumber: | 6204562323 | ||||||||
| Practice Location | |||||||||
| Address1: | 412 S 8TH ST | ||||||||
| Address2: | |||||||||
| City: | CONWAY SPRINGS | ||||||||
| State: | KS | ||||||||
| PostalCode: | 670318252 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6204562285 | ||||||||
| FaxNumber: | 6204562323 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2005 | ||||||||
| LastUpdateDate: | 03/30/2015 | ||||||||
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| AuthorizedOfficialLastName: | WINTER | ||||||||
| AuthorizedOfficialFirstName: | VIRGINIA | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 6204562285 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | N096006 | KS | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 1042721701 | 05 | KS | MEDICAID |