Provider Demographics
NPI:1699399642
Name:DAVENPORT IOWA HOMECARE LLC
Entity Type:Organization
Organization Name:DAVENPORT IOWA HOMECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BETSEY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MORTHLAND
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:309-781-0499
Mailing Address - Street 1:1895 MIDDLE ROAD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-7601
Mailing Address - Country:US
Mailing Address - Phone:309-781-0499
Mailing Address - Fax:
Practice Address - Street 1:1895 MIDDLE ROAD
Practice Address - Street 2:SUITE 201
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-7601
Practice Address - Country:US
Practice Address - Phone:309-781-0499
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-05
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive CareGroup - Single Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty
No385H00000XRespite Care FacilityRespite Care