Provider Demographics
NPI:1689678351
Name:NORTHWOODS LIVING, INC.
Entity type:Organization
Organization Name:NORTHWOODS LIVING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:A
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:515-573-8243
Mailing Address - Street 1:1470 21ST AVE. N.
Mailing Address - Street 2:
Mailing Address - City:FORT DODGE
Mailing Address - State:IA
Mailing Address - Zip Code:50501-7114
Mailing Address - Country:US
Mailing Address - Phone:515-573-8243
Mailing Address - Fax:515-576-4269
Practice Address - Street 1:1470 21ST AVE N
Practice Address - Street 2:
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-7114
Practice Address - Country:US
Practice Address - Phone:515-573-8243
Practice Address - Fax:515-576-4269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA940565251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0880526Medicaid
IA0147918Medicaid
IA0226126Medicaid