Provider Demographics
NPI:1538810270
Name:ARHC SMMDSIA01 TRS, LLC
Entity type:Organization
Organization Name:ARHC SMMDSIA01 TRS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:WELLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-372-8611
Mailing Address - Street 1:5025 RIVER VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:FORT MADISON
Mailing Address - State:IA
Mailing Address - Zip Code:52627-7605
Mailing Address - Country:US
Mailing Address - Phone:319-372-8611
Mailing Address - Fax:
Practice Address - Street 1:5025 RIVER VALLEY RD
Practice Address - Street 2:
Practice Address - City:FORT MADISON
Practice Address - State:IA
Practice Address - Zip Code:52627-7605
Practice Address - Country:US
Practice Address - Phone:319-372-8611
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-14
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility