Provider Demographics
NPI:1508085879
Name:APPLE VALLEY ASSISTED LIVING LLC.
Entity Type:Organization
Organization Name:APPLE VALLEY ASSISTED LIVING LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:COSSELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:641-357-7083
Mailing Address - Street 1:405 27TH AVE S
Mailing Address - Street 2:
Mailing Address - City:CLEAR LAKE
Mailing Address - State:IA
Mailing Address - Zip Code:50428-4002
Mailing Address - Country:US
Mailing Address - Phone:641-357-7083
Mailing Address - Fax:641-357-1512
Practice Address - Street 1:405 27TH AVE S
Practice Address - Street 2:
Practice Address - City:CLEAR LAKE
Practice Address - State:IA
Practice Address - Zip Code:50428-4002
Practice Address - Country:US
Practice Address - Phone:641-357-7083
Practice Address - Fax:641-357-1512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAS0166305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service