Healthcare Provider Details

I. General information

NPI: 1811950488
Provider Name (Legal Business Name): REGAL MANORS OF GRINNELL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 06/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

79 6TH AVE
GRINNELL IA
50112-1802
US

IV. Provider business mailing address

415 6TH AVE
GRINNELL IA
50112-1955
US

V. Phone/Fax

Practice location:
  • Phone: 641-236-6511
  • Fax: 641-236-6713
Mailing address:
  • Phone: 641-236-6511
  • Fax: 641-236-6713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. JOSEPH P DEWITT
Title or Position: CFO
Credential:
Phone: 605-217-6000