Healthcare Provider Details

I. General information

NPI: 1518975770
Provider Name (Legal Business Name): CEDAR VALLEY RANCH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2591 61ST STREET LANE
VINTON IA
52349
US

IV. Provider business mailing address

2591 61ST STREET LANE
VINTON IA
52349
US

V. Phone/Fax

Practice location:
  • Phone: 319-472-2671
  • Fax: 319-472-5068
Mailing address:
  • Phone: 319-472-2671
  • Fax: 319-472-5068

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number060691
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number060691
License Number StateIA

VIII. Authorized Official

Name: MR. WILLIAM D NELSON
Title or Position: ADMINISTRATOR
Credential: LICENSED NUSRING HOM
Phone: 319-472-2671