Provider Demographics
NPI:1639348873
Name:FRIENDSHIP VILLAGE INC.
Entity Type:Organization
Organization Name:FRIENDSHIP VILLAGE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:E
Authorized Official - Last Name:GATES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-291-8100
Mailing Address - Street 1:600 PARK LN
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50702-5200
Mailing Address - Country:US
Mailing Address - Phone:319-291-8100
Mailing Address - Fax:319-291-8324
Practice Address - Street 1:600 PARK LN
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50702-5200
Practice Address - Country:US
Practice Address - Phone:319-291-8100
Practice Address - Fax:319-291-8324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-21
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAN429314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0801332Medicaid
IA0801332Medicaid