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General NPI Number Information
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NPI Number | 1225546948
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Entity Type | Organization
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Legal Business Name | CREEKSIDE, INC
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Dates
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Enumeration Date | 01/16/2018
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Last Update Date | 07/05/2023
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Provider Practice Location Address
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Address Line | 503 WICAL WAY
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City | GRUNDY CENTER
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State | IA
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Zip | 50638-0000
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Country | US
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Telephone | 319-824-3212
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Fax |
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Provider Business Mailing Address
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Address Line | 5307 CARAWAY LN
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City | CEDAR FALLS
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State | IA
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Zip | 50613-8172
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Country | US
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Telephone | 319-277-2141
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MR. KRIS W HANSEN
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Credential |
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Telephone | 319-277-2141
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | 380114H
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License Number State | IA
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