Provider Demographics
NPI:1841274891
Name:AHF KENTUCKY IOWA, INC
Entity type:Organization
Organization Name:AHF KENTUCKY IOWA, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:T
Authorized Official - Last Name:HAEMMERLE
Authorized Official - Suffix:
Authorized Official - Credentials:CPA, INACTIVE
Authorized Official - Phone:614-760-7352
Mailing Address - Street 1:5920 VENTURE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-2236
Mailing Address - Country:US
Mailing Address - Phone:614-760-7352
Mailing Address - Fax:614-760-7356
Practice Address - Street 1:455 31ST ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IA
Practice Address - Zip Code:52302-3723
Practice Address - Country:US
Practice Address - Phone:319-377-7363
Practice Address - Fax:319-377-6022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-02
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAN604314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY10808402Medicaid
KY10808402Medicaid
IA165171Medicare Oscar/Certification