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General NPI Number Information
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NPI Number | 1679386528
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Entity Type | Organization
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Legal Business Name | JAYBIRD HOLDINGS INDIANOLA LLC
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Dates
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Enumeration Date | 01/27/2025
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Last Update Date | 01/27/2025
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Provider Practice Location Address
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Address Line | 604 E HILLCREST DR
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City | INDIANOLA
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State | IA
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Zip | 50125-9032
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Country | US
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Telephone | 515-961-1924
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Fax | 515-961-1956
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Provider Business Mailing Address
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Address Line | 604 E HILLCREST DR
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City | INDIANOLA
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State | IA
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Zip | 50125-9032
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Country | US
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Telephone | 515-961-1924
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Fax | 515-961-1956
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Authorized Official
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Title or Position | COMMUNITY DIRECTOR
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Name | JEREMY PRIOR
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Credential |
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Telephone | 515-961-1924
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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 |
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License Number State |
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