Provider Demographics
NPI:1780664789
Name:GARDEN VIEW CARE CENTER, INC.
Entity Type:Organization
Organization Name:GARDEN VIEW CARE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:DEWILD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-246-4515
Mailing Address - Street 1:1200 W NISHNA RD
Mailing Address - Street 2:
Mailing Address - City:SHENANDOAH
Mailing Address - State:IA
Mailing Address - Zip Code:51601-2116
Mailing Address - Country:US
Mailing Address - Phone:712-246-4515
Mailing Address - Fax:712-246-5085
Practice Address - Street 1:1200 W NISHNA RD
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:IA
Practice Address - Zip Code:51601-2116
Practice Address - Country:US
Practice Address - Phone:712-246-4515
Practice Address - Fax:712-246-5085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-18
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0056314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0801357Medicaid
IA165531Medicare Oscar/Certification