Provider Demographics
NPI:1982822672
Name:ONEOTA RIVERVIEW CARE FACILITY
Entity Type:Organization
Organization Name:ONEOTA RIVERVIEW CARE FACILITY
Other - Org Name:WELLINGTON PLACE ASSISTED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:L
Authorized Official - Last Name:CHENSVOLD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-362-8916
Mailing Address - Street 1:2479 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:DECORAH
Mailing Address - State:IA
Mailing Address - Zip Code:52101-7596
Mailing Address - Country:US
Mailing Address - Phone:563-382-2292
Mailing Address - Fax:563-382-9694
Practice Address - Street 1:2479 RIVER RD
Practice Address - Street 2:
Practice Address - City:DECORAH
Practice Address - State:IA
Practice Address - Zip Code:52101-7596
Practice Address - Country:US
Practice Address - Phone:563-382-2292
Practice Address - Fax:563-382-9694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2010-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAS0252310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0759977Medicaid
IA0091850Medicaid