Healthcare Provider Details

I. General information

NPI: 1033828645
Provider Name (Legal Business Name): AMERITUS IOWA CEDARVALE WHISPERING WILLOWS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2022
Last Update Date: 11/22/2022
Certification Date: 11/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 DAWN AVE
FREDERICKSBURG IA
50630-1033
US

IV. Provider business mailing address

206 BROADWAY AVE S STE 460
ROCHESTER MN
55904-7005
US

V. Phone/Fax

Practice location:
  • Phone: 563-237-5075
  • Fax:
Mailing address:
  • Phone: 507-202-8880
  • Fax:

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: MARK DICKSON
Title or Position: OWNER
Credential:
Phone: 507-202-8880