Provider Demographics
NPI:1538243266
Name:WESTHAVEN COMMUNITY A MINISTRY OF THE EVANGELICAL FREE CHURCH
Entity type:Organization
Organization Name:WESTHAVEN COMMUNITY A MINISTRY OF THE EVANGELICAL FREE CHURCH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:R
Authorized Official - Last Name:SLOAN
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:515-432-1393
Mailing Address - Street 1:112 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:IA
Mailing Address - Zip Code:50036-3305
Mailing Address - Country:US
Mailing Address - Phone:515-432-1393
Mailing Address - Fax:515-432-7882
Practice Address - Street 1:112 W 4TH ST
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:IA
Practice Address - Zip Code:50036-3305
Practice Address - Country:US
Practice Address - Phone:515-432-1393
Practice Address - Fax:515-432-7882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0801191Medicaid
IA165498Medicare Oscar/Certification