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Contact Information

VICTORIAN MANOR OF SULLIVAN
1250 EAST SPRINGFIELD RD
SULLIVAN, MO63080
 Phone: 573-437-2103
 Fax: 573-437-2219
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Assisted Living Facility

310400000X
Indicates primary specialty

NPI Profile & details for VICTORIAN MANOR OF SULLIVAN

NPI # 1407099500
LBN Legal business name VICTORIAN MANOR OF SULLIVAN
Authorized official NANCY QUICK - (SECRETARY)
Entity Organization
Organization subpart 1 No
Enumeration date 04/20/2009
Last updated 04/20/2009 - About 17 years ago
Identifiers
MO License # 26324D
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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