Provider Demographics
NPI:1114913977
Name:OTTUMWA DEVELOPMENTS INC
Entity Type:Organization
Organization Name:OTTUMWA DEVELOPMENTS INC
Other - Org Name:VISTA WOODS CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:L
Authorized Official - Last Name:STURSMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-683-3372
Mailing Address - Street 1:3 PENNSYLVANIA PL
Mailing Address - Street 2:
Mailing Address - City:OTTUMWA
Mailing Address - State:IA
Mailing Address - Zip Code:52501-2165
Mailing Address - Country:US
Mailing Address - Phone:641-683-3372
Mailing Address - Fax:641-683-1031
Practice Address - Street 1:3 PENNSYLVANIA PL
Practice Address - Street 2:
Practice Address - City:OTTUMWA
Practice Address - State:IA
Practice Address - Zip Code:52501-2165
Practice Address - Country:US
Practice Address - Phone:641-683-3372
Practice Address - Fax:641-683-1031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-26
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAN687313M00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0809012Medicaid
IA165549Medicare Oscar/Certification