Provider Demographics
NPI:1710100193
Name:ELKADER NURSING HOME COMPANY LLC
Entity Type:Organization
Organization Name:ELKADER NURSING HOME COMPANY LLC
Other - Org Name:KINGSTON COURT ASSISTED LIVING
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 1:118 REIMER ST SW
Mailing Address - Street 2:
Mailing Address - City:ELKADER
Mailing Address - State:IA
Mailing Address - Zip Code:52043-9558
Mailing Address - Country:US
Mailing Address - Phone:563-245-1620
Mailing Address - Fax:563-245-2198
Practice Address - Street 1:118 REIMER ST SW
Practice Address - Street 2:
Practice Address - City:ELKADER
Practice Address - State:IA
Practice Address - Zip Code:52043-9558
Practice Address - Country:US
Practice Address - Phone:563-245-1620
Practice Address - Fax:563-245-2198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAS0152310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0268656Medicaid