Provider Demographics
NPI:1972598498
Name:MAYFLOWER HOMES, INC.
Entity Type:Organization
Organization Name:MAYFLOWER HOMES, INC.
Other - Org Name:MAYFLOWER HOME INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:R
Authorized Official - Last Name:POUSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-236-6151
Mailing Address - Street 1:616 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:GRINNELL
Mailing Address - State:IA
Mailing Address - Zip Code:50112-2298
Mailing Address - Country:US
Mailing Address - Phone:641-236-6151
Mailing Address - Fax:641-236-6154
Practice Address - Street 1:616 BROAD ST
Practice Address - Street 2:
Practice Address - City:GRINNELL
Practice Address - State:IA
Practice Address - Zip Code:50112-2298
Practice Address - Country:US
Practice Address - Phone:641-236-6151
Practice Address - Fax:641-236-6154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-12
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0277313M00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0802303Medicaid
IA16-5481Medicare ID - Type Unspecified
IA790277Medicare Oscar/Certification