Healthcare Provider Details

I. General information

NPI: 1699768960
Provider Name (Legal Business Name): GREENBELT HOME CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1506 EDGINGTON AVE
ELDORA IA
50627-1624
US

IV. Provider business mailing address

1506 EDGINGTON AVE
ELDORA IA
50627-1624
US

V. Phone/Fax

Practice location:
  • Phone: 641-939-8444
  • Fax:
Mailing address:
  • Phone: 641-939-8444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: SHERYL KENNEDY
Title or Position: ADMINISTRATOR
Credential: R.N., B.S.
Phone: 641-939-8444