Provider Demographics
NPI:1033544655
Name:SIMPSON MEMORIAL HOME INC
Entity Type:Organization
Organization Name:SIMPSON MEMORIAL HOME INC
Other - Org Name:WILTON RETIREMENT COMMUNITY
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 1:307 OVESEN DR
Mailing Address - Street 2:
Mailing Address - City:WILTON
Mailing Address - State:IA
Mailing Address - Zip Code:52778-9568
Mailing Address - Country:US
Mailing Address - Phone:563-732-5067
Mailing Address - Fax:563-732-5068
Practice Address - Street 1:307 OVESEN DR
Practice Address - Street 2:
Practice Address - City:WILTON
Practice Address - State:IA
Practice Address - Zip Code:52778-9568
Practice Address - Country:US
Practice Address - Phone:563-732-5067
Practice Address - Fax:563-732-5068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-13
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA703215314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA165611Medicare Oscar/Certification