Provider Demographics
NPI:1285711630
Name:WELLMAN INVESTORS INC
Entity type:Organization
Organization Name:WELLMAN INVESTORS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:NICHOLLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-646-2911
Mailing Address - Street 1:516 13TH ST
Mailing Address - Street 2:
Mailing Address - City:WELLMAN
Mailing Address - State:IA
Mailing Address - Zip Code:52356-9232
Mailing Address - Country:US
Mailing Address - Phone:319-646-2911
Mailing Address - Fax:319-646-2941
Practice Address - Street 1:516 13TH ST
Practice Address - Street 2:
Practice Address - City:WELLMAN
Practice Address - State:IA
Practice Address - Zip Code:52356-9232
Practice Address - Country:US
Practice Address - Phone:319-646-2911
Practice Address - Fax:319-646-2941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAS0168310400000X
IAS0160310400000X
IA920820314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA65234OtherBCBS PROVIDER #
IA0223636Medicaid
IA0803122Medicaid
IA65234OtherBCBS PROVIDER #