Provider Demographics
NPI:1528073962
Name:IOWA VETERANS HOME
Entity type:Organization
Organization Name:IOWA VETERANS HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTING CLERK 2
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-753-4518
Mailing Address - Street 1:1301 SUMMIT ST
Mailing Address - Street 2:
Mailing Address - City:MARSHALLTOWN
Mailing Address - State:IA
Mailing Address - Zip Code:50158-5484
Mailing Address - Country:US
Mailing Address - Phone:641-753-4518
Mailing Address - Fax:641-753-4203
Practice Address - Street 1:1301 SUMMIT ST
Practice Address - Street 2:
Practice Address - City:MARSHALLTOWN
Practice Address - State:IA
Practice Address - Zip Code:50158-5484
Practice Address - Country:US
Practice Address - Phone:641-753-4518
Practice Address - Fax:641-753-4203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA3336L0003X
207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No3336L0003XSuppliersPharmacyLong Term Care PharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0088278Medicaid
IA0088278Medicaid