Healthcare Provider Details

I. General information

NPI: 1194788620
Provider Name (Legal Business Name): ELMWOOD CARE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2006
Last Update Date: 05/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 15TH ST
ONAWA IA
51040-1025
US

IV. Provider business mailing address

11523 PALMBRUSH TRL SUITE 331
LAKEWOOD RANCH FL
34202-2917
US

V. Phone/Fax

Practice location:
  • Phone: 712-423-2510
  • Fax: 712-423-1754
Mailing address:
  • Phone: 941-758-4745
  • Fax: 888-391-2373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number670321
License Number StateIA

VIII. Authorized Official

Name: MR. GREGORY S BENCH
Title or Position: AUTHORIZED REPRESENTATIVE
Credential:
Phone: 941-758-4745