Provider Demographics
NPI:1821620097
Name:FORT MADISON HEALTH CENTER OPERATIONS LLC
Entity Type:Organization
Organization Name:FORT MADISON HEALTH CENTER OPERATIONS LLC
Other - Org Name:THE MADISON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLTKAMP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-644-3479
Mailing Address - Street 1:4611 TIMBERLAND CT NE
Mailing Address - Street 2:
Mailing Address - City:SOLON
Mailing Address - State:IA
Mailing Address - Zip Code:52333-4703
Mailing Address - Country:US
Mailing Address - Phone:319-644-3479
Mailing Address - Fax:
Practice Address - Street 1:1702 41ST ST
Practice Address - Street 2:
Practice Address - City:FORT MADISON
Practice Address - State:IA
Practice Address - Zip Code:52627-3269
Practice Address - Country:US
Practice Address - Phone:319-372-8021
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-06
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility