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General NPI Number Information
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NPI Number | 1265091755
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Entity Type | Organization
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Legal Business Name | PACIFIC MANOR LLC
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Dates
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Enumeration Date | 06/10/2019
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Last Update Date | 09/15/2025
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Provider Practice Location Address
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Address Line | 105 S 6TH ST
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City | PACIFIC
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State | MO
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Zip | 63069-1328
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Country | US
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Telephone | 636-271-4222
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Fax | 636-257-8131
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Provider Business Mailing Address
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Address Line | 1220 N MAIN ST
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City | SIKESTON
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State | MO
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Zip | 63801-4827
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Country | US
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Telephone | 573-481-9625
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Fax | 573-472-0098
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Authorized Official
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Title or Position | CFO
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Name | CARLA HEDRICK
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Credential | CFO
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Telephone | 573-481-9625
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State |
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