Provider Demographics
NPI:1790781086
Name:LIEBE INC,
Entity Type:Organization
Organization Name:LIEBE INC,
Other - Org Name:CEDAR VALE ASSISTED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TERRA
Authorized Official - Middle Name:
Authorized Official - Last Name:HILLEGAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-435-4040
Mailing Address - Street 1:100 POPPE LN
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:IA
Mailing Address - Zip Code:50658-9704
Mailing Address - Country:US
Mailing Address - Phone:641-435-4040
Mailing Address - Fax:
Practice Address - Street 1:100 POPPE LN
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:IA
Practice Address - Zip Code:50658-9704
Practice Address - Country:US
Practice Address - Phone:641-435-4040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-22
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0718314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0808774Medicaid
IA165356Medicare ID - Type Unspecified