Healthcare Provider Details

I. General information

NPI: 1821620097
Provider Name (Legal Business Name): FORT MADISON HEALTH CENTER OPERATIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2020
Last Update Date: 02/06/2020
Certification Date: 02/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1702 41ST ST
FORT MADISON IA
52627-3269
US

IV. Provider business mailing address

4611 TIMBERLAND CT NE
SOLON IA
52333-4703
US

V. Phone/Fax

Practice location:
  • Phone: 319-372-8021
  • Fax:
Mailing address:
  • Phone: 319-644-3479
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: MR. MARK HOLTKAMP
Title or Position: MANAGING MEMBER
Credential:
Phone: 319-644-3479