Provider Demographics
NPI:1144216995
Name:OTTUMWA DEVELOPMENT
Entity Type:Organization
Organization Name:OTTUMWA DEVELOPMENT
Other - Org Name:OTTUMWA MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:BROERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-684-4594
Mailing Address - Street 1:927 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:OTTUMWA
Mailing Address - State:IA
Mailing Address - Zip Code:52501-2138
Mailing Address - Country:US
Mailing Address - Phone:641-684-4594
Mailing Address - Fax:641-684-9519
Practice Address - Street 1:927 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:OTTUMWA
Practice Address - State:IA
Practice Address - Zip Code:52501-2138
Practice Address - Country:US
Practice Address - Phone:641-684-4594
Practice Address - Fax:641-684-9519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA900432313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0803056Medicaid