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Premier Residential Care LLC

Organization Active NPI Assisted Living Facility · Buffalo, MO

NPI 1124275482 · NPPES record last updated Aug 19, 2008

Key facts

NPI
1124275482
Entity type
Organization (NPI type 2)
Primary specialty
Assisted Living Facility 310400000X
License
035613 (MO)
Legal business name
PREMIER RESIDENTIAL CARE LLC
Practice address
967 North Maple
Buffalo, MO 65622
Phone
(417) 345-0310
NPI assigned
Aug 19, 2008
Organization subpart
No

Authorized official

Name
Pauline S Gunter
Title
Owner/Operator
Phone
(417) 345-0310

Corporate family (same tax ID) 1

Organizations that report the same tax identification number in the National Provider Directory.

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
26D1082574Pine Lodge Residential Care
967 N Maple, Buffalo, MO 65622		Certificate of waiverApr 13, 2028

National Provider Directory

Tax ID family
Pine Lodge Residential Care (2 organizations share this tax ID)

Locations

967 N Maple St
Buffalo, MO 65622
Phone (417) 345-0310

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X 035613 MO Yes

Addresses

Primary practice location

967 North Maple
Buffalo, MO 65622

Mailing address

967 North Maple
Buffalo, MO 65622
Phone (417) 345-0310

Other identifiers

IdentifierTypeStateIssuer
1891979126MedicaidMO

Other names

  • Pine Lodge Residential Care Doing business as

Other providers in Buffalo, MO

All providers in Buffalo, MO · Assisted Living Facility in Missouri

Sources for this page

Verify at the official NPI Registry.