Healthcare Provider Details

I. General information

NPI: 1164330585
Provider Name (Legal Business Name): LEGACY OF THE MEADOWS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 E 2ND ST
DE WITT IA
52742-2140
US

IV. Provider business mailing address

PO BOX 197
DE WITT IA
52742-0197
US

V. Phone/Fax

Practice location:
  • Phone: 563-676-0020
  • Fax: 563-265-8288
Mailing address:
  • Phone: 563-676-0020
  • Fax: 563-265-8288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: GAYLE HOLQUIST
Title or Position: ADMINISTRATOR AND OWNER
Credential:
Phone: 563-676-0020