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General NPI Number Information
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NPI Number | 1144765561
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Entity Type | Organization
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Legal Business Name | ESTHERVILLE AL WINDSOR MANOR
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Dates
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Enumeration Date | 12/20/2016
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Last Update Date | 12/20/2016
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Provider Practice Location Address
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Address Line | 2015 3RD AVE N
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City | ESTHERVILLE
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State | IA
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Zip | 51334-1740
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Country | US
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Telephone | 712-362-0171
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Fax | 712-362-0034
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Provider Business Mailing Address
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Address Line | 2015 3RD AVE N
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City | ESTHERVILLE
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State | IA
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Zip | 51334-1740
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Country | US
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Telephone | 712-362-0171
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Fax | 712-362-0034
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | PATTY M YOULL
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Credential |
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Telephone | 712-362-0171
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | S0352
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License Number State | IA
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