Healthcare Provider Details

I. General information

NPI: 1407115645
Provider Name (Legal Business Name): ANCHOR HOMES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2012
Last Update Date: 11/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 N 15TH ST
CLARINDA IA
51632-1632
US

IV. Provider business mailing address

PO BOX 282
CLARINDA IA
51632-0282
US

V. Phone/Fax

Practice location:
  • Phone: 712-260-7552
  • Fax:
Mailing address:
  • Phone: 712-260-7552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number732689
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number StateIA

VIII. Authorized Official

Name: NINA MOORE
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 712-260-7552