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General NPI Number Information
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NPI Number | 1427563022
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Entity Type | Organization
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Legal Business Name | EDENCREST AT BEAVERDALE
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Dates
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Enumeration Date | 12/06/2017
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 3410 BEAVER AVE
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City | DES MOINES
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State | IA
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Zip | 50310-3271
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Country | US
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Telephone | 515-777-5105
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Fax | 515-777-1969
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Provider Business Mailing Address
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Address Line | 3410 BEAVER AVE
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City | DES MOINES
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State | IA
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Zip | 50310-3271
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Country | US
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Telephone | 515-777-5105
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Fax | 515-777-1969
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Authorized Official
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Title or Position | MANAGER
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Name | MR. SAM PATTERSON
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Credential |
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Telephone | 515-777-5105
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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 | S0369
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License Number State | IA
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