Healthcare Provider Details

I. General information

NPI: 1750379962
Provider Name (Legal Business Name): LONGVIEW HOME INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2005
Last Update Date: 10/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 LONGVIEW RD
MISSOURI VALLEY IA
51555-1227
US

IV. Provider business mailing address

1010 LONGVIEW RD
MISSOURI VALLEY IA
51555-1227
US

V. Phone/Fax

Practice location:
  • Phone: 712-642-2264
  • Fax: 712-642-2578
Mailing address:
  • Phone: 712-642-2264
  • Fax: 712-642-2578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number430093
License Number StateIA

VIII. Authorized Official

Name: JULIE DIANE NEWTON
Title or Position: ADMINISTRATOR
Credential:
Phone: 712-642-2264