Provider Demographics
NPI:1346312683
Name:MADRID HOME FOR THE AGING
Entity Type:Organization
Organization Name:MADRID HOME FOR THE AGING
Other - Org Name:BALLARD CREEK COMMUNITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KRIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-795-3007
Mailing Address - Street 1:908 N US HIGHWAY 69
Mailing Address - Street 2:
Mailing Address - City:HUXLEY
Mailing Address - State:IA
Mailing Address - Zip Code:50124-9764
Mailing Address - Country:US
Mailing Address - Phone:515-597-2555
Mailing Address - Fax:515-597-3877
Practice Address - Street 1:908 N US HIGHWAY 69
Practice Address - Street 2:
Practice Address - City:HUXLEY
Practice Address - State:IA
Practice Address - Zip Code:50124-9764
Practice Address - Country:US
Practice Address - Phone:515-597-2555
Practice Address - Fax:515-597-3877
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MADRID HOME FOR THE AGING
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-14
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAS0007310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0178210Medicaid