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VICTORIAN MANOR OF OAK GROVE/SULLIVAN
NPI 1407099500
Assisted Living Facility in Sullivan, MO

Active since April 20, 2009CLIA 26D2053542 · Waiver
1250 EAST SPRINGFIELD RD, SULLIVAN, MO 63080(573) 437-2103(573) 437-2219 Get Directions Write a Review

NPPES record last updated: April 20, 2009. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Victorian Manor Of Oak Grove/sullivan NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

VICTORIAN MANOR OF OAK GROVE/SULLIVAN (NPI 1407099500) is a healthcare organization registered as an assisted living facility in Sullivan, Missouri and active in the NPI registry since April 2009. The organization holds a CLIA Waiver certificate valid through January 31, 2027 and lists Nancy Quick, Secretary, as its authorized official.

NPPES Registry Identity

NPI1407099500
Entity TypeOrganization
Primary Taxonomy310400000X
Legal Business NameVICTORIAN MANOR OF SULLIVAN
Location Address1250 EAST SPRINGFIELD RDSullivan, MO 63080
Mailing Address1015 Springfield RdOwensville, MO 65066 · (573) 437-2103 · Fax (573) 437-2219
Phone(573) 437-2103
Fax(573) 437-2219
Organization SubpartNo
Authorized OfficialNancy QuickSecretary · (573) 437-2103
Enumeration DateApril 20, 2009
✔ NPI 1407099500 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyAssisted Living FacilityNursing & Custodial Care Facilities
Taxonomy Code310400000X
License✔ Licensed in MO · 26324D
Definition
A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being.
1250 EAST SPRINGFIELD RD, Sullivan, MO 63080
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Other Names 1

Doing Business AsVictorian Manor Of Oak Grove/sullivan

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 26D2053542

Victorian Place Of Sullivan · Sullivan, MO
Active · expires Jan 31, 2027
CLIA Number26D2053542
Laboratory TypeAssisted Living Facility
Certificate Effective DateFebruary 1, 2025
Certificate Expiration DateJanuary 31, 2027
Laboratory DirectorBrenda Bizzie
Laboratory Phone(573) 468-5217
Laboratory LocationVictorian Place Of Sullivan1250 East Springfield, Sullivan, MO 63080
CLIA data matches this NPI record on: Address
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Victorian Manor Of Sullivan's NPI number?

The NPI number for Victorian Manor Of Sullivan is 1407099500. It was assigned to this organization in the NPPES registry on April 20, 2009. The provider is doing business as Victorian Manor Of Oak Grove/Sullivan.

Where is Victorian Manor Of Sullivan located?

Victorian Manor Of Sullivan is located at 1250 East Springfield Rd, Sullivan, MO 63080. The listed phone number is (573) 437-2103.

What is Victorian Manor Of Sullivan's specialty?

The primary specialty registered for this NPI is Assisted Living Facility with taxonomy code 310400000X.

Does Victorian Manor Of Sullivan hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 26D2053542) is associated with this NPI, valid through January 31, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Victorian Manor Of Sullivan was last updated on April 20, 2009. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.