Provider Demographics
NPI:1730550583
Name:ANAMOSA AID OPCO LLC
Entity type:Organization
Organization Name:ANAMOSA AID OPCO LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:TARSNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-725-7041
Mailing Address - Street 1:330 N WABASH AVE
Mailing Address - Street 2:SUITE 3700
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3586
Mailing Address - Country:US
Mailing Address - Phone:312-725-7041
Mailing Address - Fax:
Practice Address - Street 1:1615 BRECA RIDGE DR
Practice Address - Street 2:
Practice Address - City:ANAMOSA
Practice Address - State:IA
Practice Address - Zip Code:52205-2118
Practice Address - Country:US
Practice Address - Phone:319-462-3070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-19
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA530956310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility