Provider Demographics
NPI:1114055910
Name:SIMPSON MEMORIAL HOME, INC
Entity Type:Organization
Organization Name:SIMPSON MEMORIAL HOME, INC
Other - Org Name:LELAND SMITH ASSISTED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:WICKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-627-4775
Mailing Address - Street 1:309 OVESEN DR
Mailing Address - Street 2:
Mailing Address - City:WILTON
Mailing Address - State:IA
Mailing Address - Zip Code:52778
Mailing Address - Country:US
Mailing Address - Phone:319-627-4775
Mailing Address - Fax:319-627-4738
Practice Address - Street 1:309 OVESEN DR
Practice Address - Street 2:
Practice Address - City:WILTON
Practice Address - State:IA
Practice Address - Zip Code:52778
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:2007-03-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAS0187310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0414979Medicaid