Provider Demographics
NPI:1508162264
Name:MIDWEST PROPERTIES OF IDA GROVE L.L.C.
Entity Type:Organization
Organization Name:MIDWEST PROPERTIES OF IDA GROVE L.L.C.
Other - Org Name:GOLDEN HORIZONS OF IDA GROVE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT OF MANAGEMENT
Authorized Official - Prefix:
Authorized Official - First Name:JEANA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:ROBINETTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-568-6610
Mailing Address - Street 1:800 BYRON GODBERSEN DR
Mailing Address - Street 2:
Mailing Address - City:IDA GROVE
Mailing Address - State:IA
Mailing Address - Zip Code:51445
Mailing Address - Country:US
Mailing Address - Phone:712-364-4128
Mailing Address - Fax:712-364-2002
Practice Address - Street 1:800 BYRON GODBERSEN DR
Practice Address - Street 2:
Practice Address - City:IDA GROVE
Practice Address - State:IA
Practice Address - Zip Code:51445
Practice Address - Country:US
Practice Address - Phone:712-364-4128
Practice Address - Fax:712-364-2002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-28
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAS0316310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility