Provider Demographics
NPI:1497714224
Name:BETTENDORF NURSING HOME COMPANY
Entity Type:Organization
Organization Name:BETTENDORF NURSING HOME COMPANY
Other - Org Name:BETTENDORF HEALTH CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:L
Authorized Official - Last Name:CHENSVOLD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-362-8916
Mailing Address - Street 1:PO BOX 1026
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-0018
Mailing Address - Country:US
Mailing Address - Phone:563-332-7463
Mailing Address - Fax:563-332-3656
Practice Address - Street 1:2730 CROW CREEK RD
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-2066
Practice Address - Country:US
Practice Address - Phone:563-332-7463
Practice Address - Fax:563-332-3656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-21
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA820880314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0809178Medicaid
IA16D0387557OtherCLIA
IA165280Medicare Oscar/Certification