Provider Demographics
NPI:1649266842
Name:WHITING COMMERCIAL DEVELOPMENT CORP
Entity type:Organization
Organization Name:WHITING COMMERCIAL DEVELOPMENT CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:COLLEEN
Authorized Official - Last Name:KEANE
Authorized Official - Suffix:
Authorized Official - Credentials:NHA # 075659
Authorized Official - Phone:712-458-2417
Mailing Address - Street 1:200 SHANNON DR.
Mailing Address - Street 2:
Mailing Address - City:WHITING
Mailing Address - State:IA
Mailing Address - Zip Code:51063
Mailing Address - Country:US
Mailing Address - Phone:712-458-2417
Mailing Address - Fax:712-458-2179
Practice Address - Street 1:200 SHANNON DR.
Practice Address - Street 2:
Practice Address - City:WHITING
Practice Address - State:IA
Practice Address - Zip Code:51063
Practice Address - Country:US
Practice Address - Phone:712-458-2417
Practice Address - Fax:712-458-2179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-22
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAS0149310400000X
IA670072314000000X, 311500000X, 261QR0400X, 313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
65296OtherWELLMARK BC/BS
IA0803254Medicaid
IAF247014OtherMIDLANDS CHOICE
IA0181636Medicaid
IA0652966Medicaid
IA71-00353OtherUNTIED HEALTHCARE
IA165296Medicare Oscar/Certification