Provider Demographics
NPI:1144433244
Name:GRINNELLE IOWA ASSISTED LIVING FACILITY LLC
Entity type:Organization
Organization Name:GRINNELLE IOWA ASSISTED LIVING FACILITY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:POUSH
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:641-236-8700
Mailing Address - Street 1:229 PEARL ST
Mailing Address - Street 2:
Mailing Address - City:GRINNELL
Mailing Address - State:IA
Mailing Address - Zip Code:50112-2593
Mailing Address - Country:US
Mailing Address - Phone:641-236-8700
Mailing Address - Fax:641-236-9514
Practice Address - Street 1:229 PEARL ST
Practice Address - Street 2:
Practice Address - City:GRINNELL
Practice Address - State:IA
Practice Address - Zip Code:50112-2593
Practice Address - Country:US
Practice Address - Phone:641-236-8700
Practice Address - Fax:641-236-9514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAS0224310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0477331Medicaid