Healthcare Provider Details

I. General information

NPI: 1073717153
Provider Name (Legal Business Name): MAYFLOWER HOMES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

616 BROAD ST
GRINNELL IA
50112-2298
US

IV. Provider business mailing address

616 BROAD ST
GRINNELL IA
50112-2298
US

V. Phone/Fax

Practice location:
  • Phone: 641-236-6151
  • Fax: 641-236-6154
Mailing address:
  • Phone: 641-236-6151
  • Fax: 641-236-6154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberI-277
License Number StateIA

VIII. Authorized Official

Name: MS. DENISE M. SMITH
Title or Position: FINANCIAL SECRETARY
Credential:
Phone: 641-236-6151