Healthcare Provider Details

I. General information

NPI: 1609873652
Provider Name (Legal Business Name): PARKVIEW HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2005
Last Update Date: 05/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 CSAH 9
BELVIEW MN
56214-1102
US

IV. Provider business mailing address

102 CSAH 9
BELVIEW MN
56214-1102
US

V. Phone/Fax

Practice location:
  • Phone: 507-938-4151
  • Fax: 507-938-4110
Mailing address:
  • Phone: 507-938-4151
  • Fax: 507-938-4110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number328691
License Number StateMN

VIII. Authorized Official

Name: MR. THOMAS GOERITZ
Title or Position: ADMINISTRATOR
Credential:
Phone: 507-938-4151