Healthcare Provider Details

I. General information

NPI: 1932358124
Provider Name (Legal Business Name): SHIRLEES RETIREMENT HOME INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2008
Last Update Date: 09/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1302 E 2ND AVE
INDIANOLA IA
50125-2804
US

IV. Provider business mailing address

1302 E 2ND AVE
INDIANOLA IA
50125-2804
US

V. Phone/Fax

Practice location:
  • Phone: 515-961-6673
  • Fax:
Mailing address:
  • Phone: 515-961-6673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License Number910597
License Number StateIA

VIII. Authorized Official

Name: MRS. SHIRLEE UDENE BAKER
Title or Position: PRESIDENT
Credential:
Phone: 515-961-6673