Provider Demographics
NPI:1083016174
Name:STILL WATER HOME CARE
Entity Type:Organization
Organization Name:STILL WATER HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER 1
Authorized Official - Prefix:
Authorized Official - First Name:RITA
Authorized Official - Middle Name:JOHNSON
Authorized Official - Last Name:MARTOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-441-0708
Mailing Address - Street 1:1414 E 9TH ST
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50316-2261
Mailing Address - Country:US
Mailing Address - Phone:515-441-0708
Mailing Address - Fax:
Practice Address - Street 1:1414 E 9TH ST
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50316-2261
Practice Address - Country:US
Practice Address - Phone:515-441-0708
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-19
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 148120-4251E00000X, 253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253J00000XAgenciesFoster Care Agency