Provider Demographics
NPI:1790436376
Name:ARHC SMMTEIA01 TRS, LLC
Entity Type:Organization
Organization Name:ARHC SMMTEIA01 TRS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-255-0387
Mailing Address - Street 1:3515 DIANA QUEEN DR
Mailing Address - Street 2:
Mailing Address - City:MUSCATINE
Mailing Address - State:IA
Mailing Address - Zip Code:52761-7602
Mailing Address - Country:US
Mailing Address - Phone:319-255-0387
Mailing Address - Fax:
Practice Address - Street 1:3515 DIANA QUEEN DR
Practice Address - Street 2:
Practice Address - City:MUSCATINE
Practice Address - State:IA
Practice Address - Zip Code:52761-7602
Practice Address - Country:US
Practice Address - Phone:319-255-0387
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-14
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility