Healthcare Provider Details

I. General information

NPI: 1972598498
Provider Name (Legal Business Name): MAYFLOWER HOMES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2005
Last Update Date: 10/26/2011
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 TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number0277
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0277
License Number StateIA

VIII. Authorized Official

Name: MR. EDWARD R. POUSH
Title or Position: ADMINISTRATOR
Credential:
Phone: 641-236-6151