Provider Demographics
NPI:1225546948
Name:CREEKSIDE, INC
Entity Type:Organization
Organization Name:CREEKSIDE, INC
Other - Org Name:CREEKSIDE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:KRIS
Authorized Official - Middle Name:W
Authorized Official - Last Name:HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-277-2141
Mailing Address - Street 1:5307 CARAWAY LN
Mailing Address - Street 2:
Mailing Address - City:CEDAR FALLS
Mailing Address - State:IA
Mailing Address - Zip Code:50613-8172
Mailing Address - Country:US
Mailing Address - Phone:319-277-2141
Mailing Address - Fax:
Practice Address - Street 1:503 WICAL WAY
Practice Address - Street 2:
Practice Address - City:GRUNDY CENTER
Practice Address - State:IA
Practice Address - Zip Code:50638-0000
Practice Address - Country:US
Practice Address - Phone:319-824-3212
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-16
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA380114H313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility