Provider Demographics
NPI:1245745843
Name:EDENCREST AT SIENA HILLS
Entity Type:Organization
Organization Name:EDENCREST AT SIENA HILLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:EARP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-776-6325
Mailing Address - Street 1:455 SW ANKENY RD
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023-9721
Mailing Address - Country:US
Mailing Address - Phone:515-776-6325
Mailing Address - Fax:505-777-3227
Practice Address - Street 1:455 SW ANKENY RD
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-9721
Practice Address - Country:US
Practice Address - Phone:515-776-6325
Practice Address - Fax:515-777-3227
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SIENA HILLS SENIOR LIVING, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-12-06
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAS0368310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAS0368OtherIOWA DEPARTMENT OF INSPECTIONS AND APPEALS