Provider Demographics
NPI:1851389662
Name:AMERICAN BAPTIST HOMES OF THE MIDWEST
Entity Type:Organization
Organization Name:AMERICAN BAPTIST HOMES OF THE MIDWEST
Other - Org Name:ELMCREST RETIREMENT COMMUNITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF RESIDENT RECEIVABLES
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:R
Authorized Official - Last Name:KOTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-639-3008
Mailing Address - Street 1:2104 12TH ST
Mailing Address - Street 2:
Mailing Address - City:HARLAN
Mailing Address - State:IA
Mailing Address - Zip Code:51537-2023
Mailing Address - Country:US
Mailing Address - Phone:712-755-5174
Mailing Address - Fax:712-755-5654
Practice Address - Street 1:2104 12TH ST
Practice Address - Street 2:
Practice Address - City:HARLAN
Practice Address - State:IA
Practice Address - Zip Code:51537-2023
Practice Address - Country:US
Practice Address - Phone:712-755-5174
Practice Address - Fax:712-755-5654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0800151Medicaid
IA0145220001Medicare NSC
IA0800151Medicaid