Provider Demographics
NPI:1467666792
Name:GARVIN MOSER LLC
Entity Type:Organization
Organization Name:GARVIN MOSER LLC
Other - Org Name:STONEY BROOK VILLAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:J
Authorized Official - Last Name:MOSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-350-3327
Mailing Address - Street 1:705 S PINE ST
Mailing Address - Street 2:
Mailing Address - City:WEST UNION
Mailing Address - State:IA
Mailing Address - Zip Code:52175
Mailing Address - Country:US
Mailing Address - Phone:563-422-7145
Mailing Address - Fax:563-422-5714
Practice Address - Street 1:705 S PINE ST
Practice Address - Street 2:
Practice Address - City:WEST UNION
Practice Address - State:IA
Practice Address - Zip Code:52175
Practice Address - Country:US
Practice Address - Phone:563-422-7145
Practice Address - Fax:563-422-5714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAS0238310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0749291Medicaid