Provider Demographics
NPI:1033106620
Name:SIMPSON MEMORIAL HOME INC
Entity Type:Organization
Organization Name:SIMPSON MEMORIAL HOME INC
Other - Org Name:SIMPSON MEMORIAL HOME INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DERWOOD
Authorized Official - Middle Name:G
Authorized Official - Last Name:KEITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-627-4775
Mailing Address - Street 1:1000 N MILLER ST
Mailing Address - Street 2:
Mailing Address - City:WEST LIBERTY
Mailing Address - State:IA
Mailing Address - Zip Code:52776-1102
Mailing Address - Country:US
Mailing Address - Phone:319-627-4775
Mailing Address - Fax:319-627-4738
Practice Address - Street 1:1000 N MILLER ST
Practice Address - Street 2:
Practice Address - City:WEST LIBERTY
Practice Address - State:IA
Practice Address - Zip Code:52776-1102
Practice Address - Country:US
Practice Address - Phone:319-627-4775
Practice Address - Fax:319-627-4738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-29
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
310400000X, 313M00000X, 314000000X
IA700230314000000X
IAS0187314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0803684Medicaid
IA0803684Medicaid