Provider Demographics
NPI:1194190595
Name:GREEN MEADOWS SENIOR LIVING, LLC
Entity Type:Organization
Organization Name:GREEN MEADOWS SENIOR LIVING, LLC
Other - Org Name:EDENCREST AT GREEN MEADOWS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAT
Authorized Official - Middle Name:
Authorized Official - Last Name:HANSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:515-207-1984
Mailing Address - Street 1:6750 CORPORATE DR
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON
Mailing Address - State:IA
Mailing Address - Zip Code:50131-1659
Mailing Address - Country:US
Mailing Address - Phone:515-207-1984
Mailing Address - Fax:515-777-2376
Practice Address - Street 1:6750 CORPORATE DR
Practice Address - Street 2:
Practice Address - City:JOHNSTON
Practice Address - State:IA
Practice Address - Zip Code:50131-1659
Practice Address - Country:US
Practice Address - Phone:515-207-1984
Practice Address - Fax:515-777-2376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-10
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility