MEDICARE: QHC FORT DODGE VILLA LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	0800053	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942293667
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	QHC FORT DODGE VILLA LLC

Provider Business Mailing Address
First Line	:	8350 HICKMAN RD
Second Line	:	SUITE 15
City	:	CLIVE
State	:	IA
Zip	:	50325-4311
Country	:	US
Telephone Number	:	515-276-3656
Fax Number	:	515-276-4353

Provider Business Practice Location Address
First Line	:	2721 10TH AVE N
Second Line	:
City	:	FORT DODGE
State	:	IA
Zip	:	50501-2834
Country	:	US
Telephone Number	:	515-576-7525
Fax Number	:	515-955-7528

Authorized Official
Title or Position	:	OWNER
Name	:	JERRY WILLIAM VOYNA
Credential	:	CPA
Telephone Number	:	515-276-3656

Provider Enumeration Date	:	08/28/2005
Last Update Date	:	12/15/2014

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