Provider Demographics
NPI:1295179281
Name:THE ROSE OF AMES, L.P.
Entity Type:Organization
Organization Name:THE ROSE OF AMES, L.P.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF GENERAL PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCCLENAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:952-447-2345
Mailing Address - Street 1:16670 FRANKLIN TRL SE
Mailing Address - Street 2:SUITE 240
Mailing Address - City:PRIOR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55372-2924
Mailing Address - Country:US
Mailing Address - Phone:952-447-2345
Mailing Address - Fax:952-447-2344
Practice Address - Street 1:1315 COCONINO RD
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50014-8035
Practice Address - Country:US
Practice Address - Phone:515-268-8828
Practice Address - Fax:515-292-9696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-22
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAX000588194Medicaid