Provider Demographics
NPI:1083041206
Name:SHENANDOAH IOWA ASSISTE LIVING FACILITY LLC
Entity Type:Organization
Organization Name:SHENANDOAH IOWA ASSISTE LIVING FACILITY LLC
Other - Org Name:WINDSOR MANOR SHENANDOAH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:ANN MARIE
Authorized Official - Last Name:MCCALLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-246-2194
Mailing Address - Street 1:601 HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:SHENANDOAH
Mailing Address - State:IA
Mailing Address - Zip Code:51601-2019
Mailing Address - Country:US
Mailing Address - Phone:712-246-2194
Mailing Address - Fax:712-246-6182
Practice Address - Street 1:601 HARRISON ST
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:IA
Practice Address - Zip Code:51601-2019
Practice Address - Country:US
Practice Address - Phone:712-246-2194
Practice Address - Fax:712-246-6182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-02
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAS0328311500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAS0328OtherASSISTED LIVING PROGRAM CERTIFICATE - DEPARTMENT OF INSPECTIONS AND APPEALS