Healthcare Provider Details

I. General information

NPI: 1114027208
Provider Name (Legal Business Name): EASTVIEW MANOR, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 11/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1622 E 28TH STREET
TRENTON MO
64683-1104
US

IV. Provider business mailing address

1869 CRAIG PARK CT
SAINT LOUIS MO
63146-4122
US

V. Phone/Fax

Practice location:
  • Phone: 660-359-2251
  • Fax: 660-359-6667
Mailing address:
  • Phone: 314-543-3800
  • Fax: 314-543-3880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number031838
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number041309
License Number StateMO

VIII. Authorized Official

Name: MR. ASHWIN DUNDOO
Title or Position: FINANCE
Credential:
Phone: 314-543-3800