Provider Demographics
NPI:1841243763
Name:POMEROY DEVELOPMENT CORP
Entity Type:Organization
Organization Name:POMEROY DEVELOPMENT CORP
Other - Org Name:POMEROY CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-468-2241
Mailing Address - Street 1:303 E 7TH ST
Mailing Address - Street 2:
Mailing Address - City:POMEROY
Mailing Address - State:IA
Mailing Address - Zip Code:50575-1134
Mailing Address - Country:US
Mailing Address - Phone:712-468-2241
Mailing Address - Fax:712-468-2524
Practice Address - Street 1:303 E 7TH ST
Practice Address - Street 2:
Practice Address - City:POMEROY
Practice Address - State:IA
Practice Address - Zip Code:50575-1134
Practice Address - Country:US
Practice Address - Phone:712-468-2241
Practice Address - Fax:712-468-2524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA130259314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0803312Medicaid
IA165414Medicare ID - Type Unspecified