Healthcare Provider Details

I. General information

NPI: 1538108469
Provider Name (Legal Business Name): NORTHVIEW VILLAGE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 12/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2415 N KINGSHIGHWAY BLVD
SAINT LOUIS MO
63113-1109
US

IV. Provider business mailing address

2415 N KINGSHIGHWAY BLVD
SAINT LOUIS MO
63113-1109
US

V. Phone/Fax

Practice location:
  • Phone: 314-361-1300
  • Fax: 314-361-1374
Mailing address:
  • Phone: 314-361-1300
  • Fax: 314-361-1374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number265524
License Number StateMO

VIII. Authorized Official

Name: MAKHLOUF SUISSA
Title or Position: PRESIDENT
Credential:
Phone: 314-361-1300