Provider Demographics
NPI:1851457667
Name:IOWA ODD FELLOWS & ORPHANS HOME
Entity Type:Organization
Organization Name:IOWA ODD FELLOWS & ORPHANS HOME
Other - Org Name:IOOF HOME AND COMMUNITY THERAPY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:N
Authorized Official - Last Name:HELGESON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-423-0428
Mailing Address - Street 1:1037 19TH ST SW
Mailing Address - Street 2:
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50401-6436
Mailing Address - Country:US
Mailing Address - Phone:641-423-0428
Mailing Address - Fax:641-424-1068
Practice Address - Street 1:1037 19TH ST SW
Practice Address - Street 2:
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401-6436
Practice Address - Country:US
Practice Address - Phone:641-423-0428
Practice Address - Fax:641-424-1068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA170134314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0802041Medicaid
IA0802041Medicaid