Provider Demographics
NPI:1952390072
Name:SIGNATURE PROPERTIES OF GOWRIE, LLC
Entity Type:Organization
Organization Name:SIGNATURE PROPERTIES OF GOWRIE, LLC
Other - Org Name:GOWRIE CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:H
Authorized Official - Last Name:MEHLHOP
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:515-727-1770
Mailing Address - Street 1:1808 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:GOWRIE
Mailing Address - State:IA
Mailing Address - Zip Code:50543-7438
Mailing Address - Country:US
Mailing Address - Phone:515-352-3912
Mailing Address - Fax:515-352-3377
Practice Address - Street 1:1808 MAIN STREET
Practice Address - Street 2:
Practice Address - City:GOWRIE
Practice Address - State:IA
Practice Address - Zip Code:50543-7438
Practice Address - Country:US
Practice Address - Phone:515-352-3912
Practice Address - Fax:515-352-3377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-20
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA94-0083314000000X
IA940083314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0809715Medicaid
IA0809715Medicaid