Provider Demographics
NPI:1093105975
Name:SHELLSBURG ASSOCIATES
Entity Type:Organization
Organization Name:SHELLSBURG ASSOCIATES
Other - Org Name:ROCK RIDGE RESIDENTIAL CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT OF THE BOARD
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:1605-760-1610
Mailing Address - Street 1:401 CANTON ST NW
Mailing Address - Street 2:
Mailing Address - City:SHELLSBURG
Mailing Address - State:IA
Mailing Address - Zip Code:52332-9624
Mailing Address - Country:US
Mailing Address - Phone:319-436-5570
Mailing Address - Fax:319-436-5571
Practice Address - Street 1:401 CANTON ST NW
Practice Address - Street 2:
Practice Address - City:SHELLSBURG
Practice Address - State:IA
Practice Address - Zip Code:52332-9624
Practice Address - Country:US
Practice Address - Phone:319-436-5570
Practice Address - Fax:319-436-5571
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHELLSBURG ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-01-29
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA311Z00000X311Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility