Healthcare Provider Details

I. General information

NPI: 1851389662
Provider Name (Legal Business Name): AMERICAN BAPTIST HOMES OF THE MIDWEST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2104 12TH ST
HARLAN IA
51537-2023
US

IV. Provider business mailing address

2104 12TH ST
HARLAN IA
51537-2023
US

V. Phone/Fax

Practice location:
  • Phone: 712-755-5174
  • Fax: 712-755-5654
Mailing address:
  • Phone: 712-755-5174
  • Fax: 712-755-5654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CHRISTINA R KOTZ
Title or Position: DIRECTOR OF RESIDENT RECEIVABLES
Credential:
Phone: 402-639-3008