Provider Demographics
NPI:1497741557
Name:IOWA MENNONITE BENEVOLENT ASSOCIATION
Entity Type:Organization
Organization Name:IOWA MENNONITE BENEVOLENT ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:F
Authorized Official - Last Name:POE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-656-2421
Mailing Address - Street 1:811 3RD ST
Mailing Address - Street 2:
Mailing Address - City:KALONA
Mailing Address - State:IA
Mailing Address - Zip Code:52247-9493
Mailing Address - Country:US
Mailing Address - Phone:319-656-2421
Mailing Address - Fax:319-656-2439
Practice Address - Street 1:811 3RD ST
Practice Address - Street 2:
Practice Address - City:KALONA
Practice Address - State:IA
Practice Address - Zip Code:52247-9493
Practice Address - Country:US
Practice Address - Phone:319-656-2421
Practice Address - Fax:319-656-2439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-23
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0891515311Z00000X
IA165470314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0803270Medicaid
IA0891515Medicaid
IA0891515Medicaid