Provider Demographics
NPI:1154765873
Name:THE ROSE OF COUNCIL BLUFFS, L.P.
Entity type:Organization
Organization Name:THE ROSE OF COUNCIL BLUFFS, L.P.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF GENERAL PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCCLENAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:952-447-2345
Mailing Address - Street 1:16670 FRANKLIN TRL SE
Mailing Address - Street 2:
Mailing Address - City:PRIOR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55372-2927
Mailing Address - Country:US
Mailing Address - Phone:952-447-2345
Mailing Address - Fax:952-447-2344
Practice Address - Street 1:2306 SHERWOOD DR
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-1048
Practice Address - Country:US
Practice Address - Phone:712-322-1000
Practice Address - Fax:712-352-1790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-24
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility