Provider Demographics
NPI:1346434826
Name:SHENANDOAH ENTERPRISES LLC
Entity Type:Organization
Organization Name:SHENANDOAH ENTERPRISES LLC
Other - Org Name:FAIR OAKS CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:P
Authorized Official - Last Name:DEWITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-217-6000
Mailing Address - Street 1:1201 S WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:SHENANDOAH
Mailing Address - State:IA
Mailing Address - Zip Code:51601-2176
Mailing Address - Country:US
Mailing Address - Phone:712-246-2055
Mailing Address - Fax:712-246-2099
Practice Address - Street 1:1201 S WALNUT ST
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:IA
Practice Address - Zip Code:51601-2176
Practice Address - Country:US
Practice Address - Phone:712-246-2055
Practice Address - Fax:712-246-2099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-28
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility