Healthcare Provider Details

I. General information

NPI: 1790880383
Provider Name (Legal Business Name): FRIENDS OF FAITH RETIREMENT HOMES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 06/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 PARK LN
WATERLOO IA
50702-5299
US

IV. Provider business mailing address

600 PARK LN
WATERLOO IA
50702-5299
US

V. Phone/Fax

Practice location:
  • Phone: 319-291-8100
  • Fax: 319-291-8324
Mailing address:
  • Phone: 319-291-8100
  • Fax: 319-291-8324

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0801332
License Number StateIA

VIII. Authorized Official

Name: LISA E GATES
Title or Position: EXECUTIVE DIRECTOR
Credential: NHA
Phone: 319-291-8100