Healthcare Provider Details

I. General information

NPI: 1699367615
Provider Name (Legal Business Name): HIGLEY MANSION CARE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2021
Last Update Date: 02/10/2021
Certification Date: 02/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

860 17TH STREET SE
CEDAR RAPIDS IA
52403
US

IV. Provider business mailing address

860 17TH STREET SE
CEDAR RAPIDS IA
52403
US

V. Phone/Fax

Practice location:
  • Phone: 319-364-6710
  • Fax: 319-364-5918
Mailing address:
  • Phone: 319-364-6710
  • Fax: 319-364-5918

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment 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: MRS. JUDY ARLENE TUCKER
Title or Position: ADMINISTRATOR
Credential: LNHA
Phone: 319-364-6710