Provider Demographics
NPI:1356317820
Name:FELLOWSHIP VILLAGE
Entity Type:Organization
Organization Name:FELLOWSHIP VILLAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:R
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-753-4663
Mailing Address - Street 1:300 E JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:INWOOD
Mailing Address - State:IA
Mailing Address - Zip Code:51240-7766
Mailing Address - Country:US
Mailing Address - Phone:712-753-4663
Mailing Address - Fax:712-753-4666
Practice Address - Street 1:300 E JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:INWOOD
Practice Address - State:IA
Practice Address - Zip Code:51240-7766
Practice Address - Country:US
Practice Address - Phone:712-753-4663
Practice Address - Fax:712-753-4666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-24
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAN-0572314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0807891Medicaid
IA165283Medicare Oscar/Certification