Organization Name: | SPIRIT LAKE HEALTHCARE LLC |
NPI Number: | 1063870152 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | RICHARD AGNER (CHIEF FINANCIAL OFFICER) |
Mailing Address: | 1819 23rd St Spirit Lake |
State: | IA US |
Postal Code: | 513607096 |
Phone Number: | 7123363553 |
Fax Number: | 7123365717 |
NPI Enumeration Date: | 02/03/2016 |
NPI Last Update Date: | 02/03/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 310400000X |
License Number: | S0025 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IA |
Taxonomy Type: | Nursing & Custodial Care Facilities |
Taxonomy Classification: | Assisted Living Facility |
Taxonomy Specialization: | |
Taxonomy Definition: | A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. |