Provider Demographics
NPI:1275530883
Name:U.S.A. HEALTHCARE CENTER-URBANDALE, L.L.C.
Entity Type:Organization
Organization Name:U.S.A. HEALTHCARE CENTER-URBANDALE, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.F.O.
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:HUTTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-739-1239
Mailing Address - Street 1:4614 84TH ST
Mailing Address - Street 2:
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50322-1089
Mailing Address - Country:US
Mailing Address - Phone:515-278-6838
Mailing Address - Fax:515-278-5693
Practice Address - Street 1:4614 84TH ST
Practice Address - Street 2:
Practice Address - City:URBANDALE
Practice Address - State:IA
Practice Address - Zip Code:50322-1089
Practice Address - Country:US
Practice Address - Phone:515-278-6838
Practice Address - Fax:515-278-5693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-29
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA770053314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA65580OtherBCBS
IA0800000Medicaid
IA165580Medicare Oscar/Certification