Provider Demographics
NPI:1437365731
Name:ROTARY CLUB OF ROCK VALLEY FOUNDATION, INC.
Entity Type:Organization
Organization Name:ROTARY CLUB OF ROCK VALLEY FOUNDATION, INC.
Other - Org Name:SENIOR COMPANION PROGRAM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-476-2628
Mailing Address - Street 1:1510 14TH ST
Mailing Address - Street 2:
Mailing Address - City:ROCK VALLEY
Mailing Address - State:IA
Mailing Address - Zip Code:51247-1207
Mailing Address - Country:US
Mailing Address - Phone:712-476-2628
Mailing Address - Fax:712-476-3457
Practice Address - Street 1:1510 14TH ST
Practice Address - Street 2:
Practice Address - City:ROCK VALLEY
Practice Address - State:IA
Practice Address - Zip Code:51247-1207
Practice Address - Country:US
Practice Address - Phone:712-476-2628
Practice Address - Fax:712-476-3457
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0469841251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0469841Medicaid