Provider Demographics
NPI:1013375310
Name:LAN SILVER PINES LLC
Entity Type:Organization
Organization Name:LAN SILVER PINES LLC
Other - Org Name:BROOKDALE CEDAR RAPIDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:SHANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:LONDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-623-6239
Mailing Address - Street 1:4252 MANOR DR
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:VA
Mailing Address - Zip Code:20115-3701
Mailing Address - Country:US
Mailing Address - Phone:540-364-0155
Mailing Address - Fax:540-364-0446
Practice Address - Street 1:136 36TH AVE SW
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52404-4638
Practice Address - Country:US
Practice Address - Phone:319-362-6868
Practice Address - Fax:319-363-7312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-02
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility