Provider Demographics
NPI:1679112841
Name:ARHC PSINDIA01 TRS
Entity type:Organization
Organization Name:ARHC PSINDIA01 TRS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:
Authorized Official - Last Name:INGERSOLL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-334-2000
Mailing Address - Street 1:505 ENTERPRISE DR
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:IA
Mailing Address - Zip Code:50644-9603
Mailing Address - Country:US
Mailing Address - Phone:319-334-2000
Mailing Address - Fax:319-334-3015
Practice Address - Street 1:505 ENTERPRISE DR
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:IA
Practice Address - Zip Code:50644-9603
Practice Address - Country:US
Practice Address - Phone:319-334-2000
Practice Address - Fax:319-334-3015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-05
Last Update Date:2020-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility