Healthcare Provider Details

I. General information

NPI: 1508958265
Provider Name (Legal Business Name): ALLEN MEMORIAL HOSPITAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 10/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 LOGAN AVE
WATERLOO IA
50703-1916
US

IV. Provider business mailing address

PO BOX 7326
DES MOINES IA
50309-7326
US

V. Phone/Fax

Practice location:
  • Phone: 319-235-3941
  • Fax:
Mailing address:
  • Phone: 319-235-3941
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number070034H
License Number StateIA

VIII. Authorized Official

Name: MS. RENEE RASMUSSEN
Title or Position: CFO
Credential:
Phone: 319-235-3918