Provider Demographics
NPI:1730123563
Name:VILLAGE NORTHWEST UNLIMITED
Entity Type:Organization
Organization Name:VILLAGE NORTHWEST UNLIMITED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:W
Authorized Official - Last Name:WHITSELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-324-4873
Mailing Address - Street 1:330 VILLAGE CIR
Mailing Address - Street 2:
Mailing Address - City:SHELDON
Mailing Address - State:IA
Mailing Address - Zip Code:51201-1243
Mailing Address - Country:US
Mailing Address - Phone:712-324-4873
Mailing Address - Fax:712-324-4877
Practice Address - Street 1:330 VILLAGE CIR
Practice Address - Street 2:
Practice Address - City:SHELDON
Practice Address - State:IA
Practice Address - Zip Code:51201-1243
Practice Address - Country:US
Practice Address - Phone:712-324-4873
Practice Address - Fax:712-324-4877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251C00000XAgenciesDay Training, Developmentally Disabled Services
Not Answered311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
Not Answered315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0890988Medicaid
IA0094615Medicaid
IA0880039Medicaid
IA0894949Medicaid