Healthcare Provider Details

I. General information

NPI: 1649266842
Provider Name (Legal Business Name): WHITING COMMERCIAL DEVELOPMENT CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2005
Last Update Date: 01/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 SHANNON DR.
WHITING IA
51063
US

IV. Provider business mailing address

200 SHANNON DR.
WHITING IA
51063
US

V. Phone/Fax

Practice location:
  • Phone: 712-458-2417
  • Fax: 712-458-2179
Mailing address:
  • Phone: 712-458-2417
  • Fax: 712-458-2179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number670072
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberS0149
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number670072
License Number StateIA
# 4
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number670072
License Number StateIA
# 5
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number670072
License Number StateIA

VIII. Authorized Official

Name: MS. KATHRYN COLLEEN KEANE
Title or Position: ADMINISTRATOR
Credential: NHA # 075659
Phone: 712-458-2417