Provider Demographics
NPI:1891915245
Name:SIGNATURE PROPERTIES OF WAUKEE, LLC
Entity Type:Organization
Organization Name:SIGNATURE PROPERTIES OF WAUKEE, LLC
Other - Org Name:THE VILLAGE AT LEGACY POINTE NURSING FACILITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:MEHLHOP
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:515-727-1770
Mailing Address - Street 1:8101 BIRCHWOOD CT
Mailing Address - Street 2:PO BOX 917
Mailing Address - City:JOHNSTON
Mailing Address - State:IA
Mailing Address - Zip Code:50131-2930
Mailing Address - Country:US
Mailing Address - Phone:515-727-1770
Mailing Address - Fax:515-727-1771
Practice Address - Street 1:1645 SE HOLIDAY CREST CIRCLE
Practice Address - Street 2:
Practice Address - City:WAUKEE
Practice Address - State:IA
Practice Address - Zip Code:50263
Practice Address - Country:US
Practice Address - Phone:515-987-3625
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility