Healthcare Provider Details

I. General information

NPI: 1679575278
Provider Name (Legal Business Name): ABCM CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 10/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 US HIGHWAY 18 W
CLEAR LAKE IA
50428-1108
US

IV. Provider business mailing address

1320 4TH ST NE
HAMPTON IA
50441-1104
US

V. Phone/Fax

Practice location:
  • Phone: 641-357-5244
  • Fax: 641-357-7154
Mailing address:
  • Phone: 641-456-5636
  • Fax: 641-456-2320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number170382
License Number StateIA

VIII. Authorized Official

Name: TIMOTHY ROBERTS
Title or Position: CFO
Credential:
Phone: 641-456-5636