Basic Information
| Provider Information | |||||||||
| NPI: | 1134271422 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | STONEHILL FRANCISCAN SERVICES | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | STONEHILL ADULT CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 3485 WINDSOR AVE | ||||||||
| Address2: | |||||||||
| City: | DUBUQUE | ||||||||
| State: | IA | ||||||||
| PostalCode: | 520011329 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5635570849 | ||||||||
| FaxNumber: | 5635849282 | ||||||||
| Practice Location | |||||||||
| Address1: | 3485 WINDSOR AVE | ||||||||
| Address2: | |||||||||
| City: | DUBUQUE | ||||||||
| State: | IA | ||||||||
| PostalCode: | 520011329 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5635570849 | ||||||||
| FaxNumber: | 5635849282 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/17/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | GRABBERT | ||||||||
| AuthorizedOfficialFirstName: | JERI | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | FINANCE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 5635570849 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
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| AuthorizedOfficialCredential: | CPA | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA0600X | AADS505 | IA | Y | Ambulatory Health Care Facilities | Clinic/Center | Adult Day Care |
ID Information
| ID | Type | State | Issuer | Description | 0108571 | 05 | IA | MEDICAID |