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General NPI Number Information
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NPI Number | 1043208671
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Entity Type | Organization
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Legal Business Name | ROTARY CLUB OF EAGLE GROVE HOME INC
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Dates
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Enumeration Date | 10/07/2005
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Last Update Date | 08/11/2010
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Provider Practice Location Address
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Address Line | 500 S BLAINE AVE
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City | EAGLE GROVE
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State | IA
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Zip | 50533-2429
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Country | US
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Telephone | 515-448-5123
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Fax |
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Provider Business Mailing Address
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Address Line | 620 SE 5TH ST
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City | EAGLE GROVE
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State | IA
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Zip | 50533-2477
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Country | US
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Telephone | 515-448-5124
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Fax | 515-448-5167
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | STEPHANIE MORRIS
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Credential |
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Telephone | 515-448-5124
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311Z00000X
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Taxonomy Name | Custodial Care Facility
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License Number | 990615
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 990337
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License Number State | IA
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