Provider Demographics
NPI:1437362886
Name:GARNETT PLACE RETIREMENT COMMUNITY
Entity Type:Organization
Organization Name:GARNETT PLACE RETIREMENT COMMUNITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MALCOM
Authorized Official - Middle Name:
Authorized Official - Last Name:SIGLER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:319-362-3630
Mailing Address - Street 1:208 35TH STREET DR SE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52403-1357
Mailing Address - Country:US
Mailing Address - Phone:319-362-3630
Mailing Address - Fax:319-247-5791
Practice Address - Street 1:208 35TH STREET DR SE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52403-1357
Practice Address - Country:US
Practice Address - Phone:319-362-3630
Practice Address - Fax:319-247-5791
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAS0113310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0470203Medicaid