Healthcare Provider Details

I. General information

NPI: 1033106620
Provider Name (Legal Business Name): SIMPSON MEMORIAL HOME INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 11/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 N MILLER ST
WEST LIBERTY IA
52776-1102
US

IV. Provider business mailing address

1000 N MILLER ST
WEST LIBERTY IA
52776-1102
US

V. Phone/Fax

Practice location:
  • Phone: 319-627-4775
  • Fax: 319-627-4738
Mailing address:
  • Phone: 319-627-4775
  • Fax: 319-627-4738

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number700230
License Number StateIA
# 5
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberS0187
License Number StateIA

VIII. Authorized Official

Name: DERWOOD G KEITH
Title or Position: PRESIDENT
Credential:
Phone: 319-627-4775