Healthcare Provider Details

I. General information

NPI: 1821113408
Provider Name (Legal Business Name): PINE VIEW CHRISTIAN HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4281 HIGHWAY 17
SUMMERSVILLE MO
65571-8204
US

IV. Provider business mailing address

305 HORAK DR
WILLOW SPRINGS MO
65793-3576
US

V. Phone/Fax

Practice location:
  • Phone: 417-932-4557
  • Fax: 417-932-4558
Mailing address:
  • Phone: 417-932-4557
  • Fax: 417-932-4558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: MRS. SANDRA KAY SMITH
Title or Position: QMRP
Credential:
Phone: 417-932-4557