Provider Demographics
NPI:1679608558
Name:COUNTRY VIEW ESTATES, INC.
Entity Type:Organization
Organization Name:COUNTRY VIEW ESTATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO - ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:OBERHOLTZ
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?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0895623Medicaid