Provider Demographics
NPI:1376707760
Name:FOX RUN ASSISTED LIVING OPERATING, LLC
Entity Type:Organization
Organization Name:FOX RUN ASSISTED LIVING OPERATING, LLC
Other - Org Name:FOX RUN ASSISTED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:JUDKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-256-2741
Mailing Address - Street 1:3121 MACINEERY DR
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51501-8591
Mailing Address - Country:US
Mailing Address - Phone:712-256-2741
Mailing Address - Fax:712-256-7609
Practice Address - Street 1:3121 MACINEERY DR
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51501-8591
Practice Address - Country:US
Practice Address - Phone:712-256-2741
Practice Address - Fax:712-256-7609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-15
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IASO193310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA030538388Medicaid