Healthcare Provider Details

I. General information

NPI: 1174313209
Provider Name (Legal Business Name): JAYBIRD SENIOR LIVING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2025
Last Update Date: 05/12/2025
Certification Date: 05/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 35TH STREET DR SE
CEDAR RAPIDS IA
52403-1323
US

IV. Provider business mailing address

200 35TH STREET DR SE
CEDAR RAPIDS IA
52403-1323
US

V. Phone/Fax

Practice location:
  • Phone: 800-366-6716
  • Fax: 319-362-3067
Mailing address:
  • Phone: 800-366-6716
  • Fax: 319-362-3067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: KEVIN RUSSELL
Title or Position: OWNER
Credential:
Phone: 800-366-6716