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General NPI Number Information
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NPI Number | 1780686220
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Entity Type | Organization
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Legal Business Name | MIDLANDS LIVING CENTER, L.L.P.
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Dates
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Enumeration Date | 08/15/2005
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Last Update Date | 10/26/2011
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Provider Practice Location Address
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Address Line | 2452 N BROADWAY
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City | COUNCIL BLUFFS
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State | IA
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Zip | 51503-0434
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Country | US
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Telephone | 712-323-7135
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Fax | 712-325-0289
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Provider Business Mailing Address
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Address Line | 2452 N BROADWAY
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City | COUNCIL BLUFFS
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State | IA
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Zip | 51503-0432
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Country | US
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Telephone | 712-323-7135
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Fax | 712-325-0289
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MARK A. ANDERSON
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Credential |
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Telephone | 712-323-7135
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 780508
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License Number State | IA
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