Provider Demographics
NPI:1013910553
Name:KAHL HOME FOR THE AGED & INFIRM
Entity Type:Organization
Organization Name:KAHL HOME FOR THE AGED & INFIRM
Other - Org Name:KAHL HOME FOR THE AGED & INFIRM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR/TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:HUFSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-484-3813
Mailing Address - Street 1:6701 JERSEY RIDGE ROAD
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-3203
Mailing Address - Country:US
Mailing Address - Phone:563-324-1621
Mailing Address - Fax:563-324-1723
Practice Address - Street 1:6701 JERSEY RIDGE ROAD
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807
Practice Address - Country:US
Practice Address - Phone:563-324-1621
Practice Address - Fax:563-324-1723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-28
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA820128314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0802108Medicaid
IA165146OtherWELLMARK BLUE CROSS
IA165146OtherMEDICARE