Provider Demographics
NPI:1134295835
Name:VILLAGE NORTHWEST UNLIMITED
Entity Type:Organization
Organization Name:VILLAGE NORTHWEST UNLIMITED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITSELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-324-4873
Mailing Address - Street 1:330 VILLAGE CIR
Mailing Address - Street 2:
Mailing Address - City:SHELDON
Mailing Address - State:IA
Mailing Address - Zip Code:51201-1243
Mailing Address - Country:US
Mailing Address - Phone:712-324-4873
Mailing Address - Fax:712-324-4877
Practice Address - Street 1:330 VILLAGE CIR
Practice Address - Street 2:
Practice Address - City:SHELDON
Practice Address - State:IA
Practice Address - Zip Code:51201-1243
Practice Address - Country:US
Practice Address - Phone:712-324-4873
Practice Address - Fax:712-324-4877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0890988311Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0890988OtherRCFMR