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General NPI Number Information
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NPI Number | 1750412672
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Entity Type | Organization
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Legal Business Name | PROFFITT'S RESIDENTIAL
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Dates
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Enumeration Date | 03/09/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 615 WEST WASHINGTON ST
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City | CENTERVILLE
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State | IA
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Zip | 52544-1623
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Country | US
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Telephone | 641-856-8344
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Fax | 641-437-4161
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Provider Business Mailing Address
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Address Line | 615 W WASHINGTON ST
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City | CENTERVILLE
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State | IA
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Zip | 52544-1623
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Country | US
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Telephone | 641-856-8344
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Fax | 641-437-4161
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Authorized Official
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Title or Position | OWNER
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Name | MARY CATHERINE PROFFITT
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Credential |
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Telephone | 641-856-8344
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | R542
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License Number State | IA
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