Provider Demographics
NPI:1346785094
Name:QHC VILLA COTTAGES LLC
Entity Type:Organization
Organization Name:QHC VILLA COTTAGES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:VOYNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-276-3656
Mailing Address - Street 1:925 MARTIN LUTHER KING DR
Mailing Address - Street 2:
Mailing Address - City:FORT DODGE
Mailing Address - State:IA
Mailing Address - Zip Code:50501-2866
Mailing Address - Country:US
Mailing Address - Phone:515-576-6525
Mailing Address - Fax:515-573-3968
Practice Address - Street 1:925 MARTIN LUTHER KING DR
Practice Address - Street 2:
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-2866
Practice Address - Country:US
Practice Address - Phone:515-576-6525
Practice Address - Fax:515-573-3968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-04
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAS0051310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility