Provider Demographics
NPI:1659330470
Name:ANAMOSA NURSING HOME COMPANY LLC
Entity Type:Organization
Organization Name:ANAMOSA NURSING HOME COMPANY LLC
Other - Org Name:ANAMOSA CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:L
Authorized Official - Last Name:CHENSVOLD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-362-8916
Mailing Address - Street 1:1209 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:ANAMOSA
Mailing Address - State:IA
Mailing Address - Zip Code:52205-1503
Mailing Address - Country:US
Mailing Address - Phone:319-462-4356
Mailing Address - Fax:319-462-5038
Practice Address - Street 1:1209 E 3RD ST
Practice Address - Street 2:
Practice Address - City:ANAMOSA
Practice Address - State:IA
Practice Address - Zip Code:52205-1503
Practice Address - Country:US
Practice Address - Phone:319-462-4356
Practice Address - Fax:319-462-5038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-21
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA530253314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0809160Medicaid
IA0809160Medicaid