Provider Demographics
NPI:1679392252
Name:PASADENA VILLA IOWA LLC
Entity type:Organization
Organization Name:PASADENA VILLA IOWA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:SARNACKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-442-7689
Mailing Address - Street 1:5405 UTICA RIDGE RD STE 206
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-2938
Mailing Address - Country:US
Mailing Address - Phone:563-484-7798
Mailing Address - Fax:
Practice Address - Street 1:5405 UTICA RIDGE RD STE 206
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-2938
Practice Address - Country:US
Practice Address - Phone:563-484-7798
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-09
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health