=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700888237
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ABCM CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/15/2005
-----------------------------------------------------
Last Update Date | 09/15/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 200 WASHINGTON ST
-----------------------------------------------------
City | MORNING SUN
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 52640-7637
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 319-868-7751
-----------------------------------------------------
Fax | 319-868-7742
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1320 4TH ST NE
-----------------------------------------------------
City | HAMPTON
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50441-1104
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 641-456-5636
-----------------------------------------------------
Fax | 641-456-2320
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | RICHARD ALLBEE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 641-456-5636
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number | 580349
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------