Provider Demographics
NPI:1508857582
Name:PRESBYTERIAN VILLAGE
Entity Type:Organization
Organization Name:PRESBYTERIAN VILLAGE
Other - Org Name:COMMUNITY OUTREACH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HINDERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-847-3531
Mailing Address - Street 1:502 BUTLER ST
Mailing Address - Street 2:
Mailing Address - City:ACKLEY
Mailing Address - State:IA
Mailing Address - Zip Code:50601-1730
Mailing Address - Country:US
Mailing Address - Phone:641-847-3531
Mailing Address - Fax:641-847-3428
Practice Address - Street 1:502 BUTLER ST
Practice Address - Street 2:
Practice Address - City:ACKLEY
Practice Address - State:IA
Practice Address - Zip Code:50601-1730
Practice Address - Country:US
Practice Address - Phone:641-847-3531
Practice Address - Fax:641-847-3428
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRESBYTERIAN VILLAGE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-10-31
Last Update Date:2009-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAN-418332U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332U00000XSuppliersHome Delivered Meals
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0158766Medicaid