Provider Demographics
NPI:1235135195
Name:HERMAN L. ROWLEY MEMORIAL TRUST
Entity Type:Organization
Organization Name:HERMAN L. ROWLEY MEMORIAL TRUST
Other - Org Name:ROWLEY MEMORIAL MASONIC HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LUCINDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:FRIESS
Authorized Official - Suffix:
Authorized Official - Credentials:RN LNHA
Authorized Official - Phone:515-465-5316
Mailing Address - Street 1:PO BOX 578
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:IA
Mailing Address - Zip Code:50220-0578
Mailing Address - Country:US
Mailing Address - Phone:515-465-5316
Mailing Address - Fax:515-465-4869
Practice Address - Street 1:3000 WILLIS AVENUE
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:IA
Practice Address - Zip Code:50220-0578
Practice Address - Country:US
Practice Address - Phone:515-465-5316
Practice Address - Fax:515-465-4869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0459314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0803544Medicaid
IA0803544Medicaid