Peaceful Pines Residential Care, Inc.

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

032744 Issued in MO

Legal business name

PEACEFUL PINES RESIDENTIAL CARE, INC.

Practice address

614 County Road 466
Poplar Bluff, MO 63901-2964

Phone

(573) 778-0497

NPI assigned

Sep 1, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kimberly Menckowski

Title

Administrator

Phone

(573) 714-2838

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1157068800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1942302005",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "614 COUNTY ROAD 466",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639012964",
            "telephone_number": "573-778-0497"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "614 COUNTY ROAD 466",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639012964",
            "telephone_number": "573-778-0497"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEACEFUL PINES RESIDENTIAL CARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-01",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MENCKOWSKI",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "573-714-2838"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "MO",
            "license": "032744",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Panagiotis Paulus, M.D.
• Raymond Dean Paxton, LCSW
• Alisha Payne
• Lisa Marie Payne, DPT
• Rhonda Lea Payne
• Michael R. Penney, OD
• Amy Michelle Pennington, NP
• Stefanie Sue Pennington, LPN
• Theresa Louise Pennington, FNP-BC
• Timothy Paul Pennington, LCSW

• Assisted Living Facility in Poplar Bluff, MO
• Providers in Poplar Bluff, MO by specialty
• Assisted Living Facility in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.