PINEVIEW GROUP HOME
NPI 1841452109
Intermediate Care Facility, Intellectual Disabilities in Urbana, MO

Q: What is the provider's specialty?

The provider's specialty is Intermediate Care Facility, Intellectual Disabilities with taxonomy code 315P00000X.

Active since June 27, 2008

27 HOPPER TRL, URBANA, MO 65767(417) 722-4416(417) 722-4417 Get Directions Write a Review

NPPES record last updated: June 27, 2008. Verified against the NPPES registry weekly; last sync: July 19, 2026.

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NPI Profile Information
Primary Taxonomy
Authorized Official
Other Providers Same Location
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Organization
Intermediate Care Facility, Intellectual...

About PINEVIEW GROUP HOME

This page provides the complete NPI Profile along with additional information for Pineview Group Home, a provider established in Urbana, Missouri operating as a Intermediate Care Facility, Intellectual Disabilities. The healthcare provider is registered in the NPI registry with number 1841452109 assigned on June 2008. The practitioner's primary taxonomy code is 315P00000X with license number LC0556542 (MO). The provider is registered as an organization and their NPI record was last updated 18 years ago. The provider's other name is Pineview Group Home. The authorized official of this NPI record is Mr. Gary D Boggs (Director)

NPI: 1841452109 Verify this NPI
Provider Legal Name: EVERGREEN GROUP HOME
Other Organization Name: PINEVIEW GROUP HOME
Other Name Type: Other Name (5)
Entity Type: Organization
Location Address: 27 HOPPER TRL URBANA, MO 65767
Location Phone: (417) 722-4416
Location Fax: (417) 722-4417
Mailing Address: 27 HOPPER TRL URBANA, MO 65767
Mailing Phone: (417) 722-4416
Mailing Fax: (417) 722-4417
Is Sole Proprietor?: No
Is Organization Subpart?: No
Enumeration Date: 06-27-2008
Last Update Date: 06-27-2008
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Specialty - Primary Taxonomy

The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Classification: Intermediate Care Facility, Intellectual Disabilities
Taxonomy Code: 315P00000X
Type: Nursing & Custodial Care Facilities
License No.: LC0556542
License State: MO
Taxonomy Description: An intermediate care facility providing services for individuals with intellectual disabilities.

Authorized Official

The authorized official is the designated individual with the legal authority to make changes to the provider’s official NPI record. For organizations, the authorized official must be a general partner, chairman of the board, CEO, CFO or a direct owner holding at least a 5 percent stake in the medical organization.

Authorized Official Name: MR. GARY D BOGGS
Authorized Official Title: DIRECTOR
Authorized Official Phone: (417) 722-4416