Provider Demographics
NPI:1598018707
Name:COUNTRY VIEW ESTATES, INC.
Entity Type:Organization
Organization Name:COUNTRY VIEW ESTATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:RANDEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-755-2125
Mailing Address - Street 1:2345 REDWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:GUTHRIE CENTER
Mailing Address - State:IA
Mailing Address - Zip Code:50115-8888
Mailing Address - Country:US
Mailing Address - Phone:641-755-2125
Mailing Address - Fax:641-755-2863
Practice Address - Street 1:2345 REDWOOD AVE
Practice Address - Street 2:
Practice Address - City:GUTHRIE CENTER
Practice Address - State:IA
Practice Address - Zip Code:50115-8888
Practice Address - Country:US
Practice Address - Phone:641-755-2125
Practice Address - Fax:641-755-2863
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTRY VIEW ESTATES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-10-25
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAR - 695311Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1679608558Medicaid
IA1588709976Medicaid