Provider Demographics
NPI:1861534265
Name:MAKEE MANOR INC
Entity type:Organization
Organization Name:MAKEE MANOR INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLINGSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-568-4266
Mailing Address - Street 1:877 HIGHWAY 9
Mailing Address - Street 2:
Mailing Address - City:WAUKON
Mailing Address - State:IA
Mailing Address - Zip Code:52172-7757
Mailing Address - Country:US
Mailing Address - Phone:563-568-4266
Mailing Address - Fax:563-568-6986
Practice Address - Street 1:877 HIGHWAY 9
Practice Address - Street 2:
Practice Address - City:WAUKON
Practice Address - State:IA
Practice Address - Zip Code:52172-7757
Practice Address - Country:US
Practice Address - Phone:563-568-4266
Practice Address - Fax:563-568-6986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA030709311Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0450676Medicaid
IA0895748Medicaid
IA0746933Medicaid
IA0233387Medicaid