Healthcare Provider Details

I. General information

NPI: 1902057185
Provider Name (Legal Business Name): URBANDALE HEALTH CARE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2008
Last Update Date: 10/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4614 84TH ST
URBANDALE IA
50322-1089
US

IV. Provider business mailing address

4614 84TH ST
URBANDALE IA
50322-1089
US

V. Phone/Fax

Practice location:
  • Phone: 515-270-6838
  • Fax: 515-278-5693
Mailing address:
  • Phone: 515-270-6838
  • Fax: 515-278-5693

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: MRS. CYNTHIA RENE ROTH
Title or Position: CONTROLLER
Credential:
Phone: 317-557-1190