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General NPI Number Information
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NPI Number | 1417174772
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Entity Type | Organization
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Legal Business Name | ODEBOLT ASSISTED LIVING, L.L.C.
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Dates
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Enumeration Date | 04/19/2007
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Last Update Date | 11/10/2022
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Provider Practice Location Address
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Address Line | 799 S. DES MOINES
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City | ODEBOLT
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State | IA
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Zip | 51458
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Country | US
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Telephone | 712-668-4867
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Fax | 712-668-2268
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Provider Business Mailing Address
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Address Line | 799 S. DES MOINES
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City | ODEBOLT
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State | IA
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Zip | 51458
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Country | US
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Telephone | 712-668-4867
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Fax | 712-668-2268
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Authorized Official
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Title or Position | SVP/CFO
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Name | DAVID DIXON
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Credential |
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Telephone | 515-224-4442
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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 | S0250
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License Number State | IA
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