Healthcare Provider Details

I. General information

NPI: 1538477112
Provider Name (Legal Business Name): ABBE CENTER FOR CMH @ MAPLE CREST NURSING HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2010
Last Update Date: 09/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 11TH ST NW
CEDAR RAPIDS IA
52405-3811
US

IV. Provider business mailing address

100 BOLGER DR
FAYETTE IA
52142-9762
US

V. Phone/Fax

Practice location:
  • Phone: 319-398-3562
  • Fax: 319-398-3501
Mailing address:
  • Phone: 563-425-3336
  • Fax: 563-422-5368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VII. Legacy identifiers

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

# 1
Identifier0074575
Identifier TypeMEDICAID
Identifier StateIA
Identifier Issuer

VIII. Authorized Official

Name: CINDY KAESTNER
Title or Position: DIRECTOR
Credential: LISW
Phone: 319-398-3562