Basic Information
Provider Information | |||||||||
NPI: | 1306839501 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | WASHINGTON CARE CENTER | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 601 E POLK ST | ||||||||
Address2: | P.O. BOX 892 | ||||||||
City: | WASHINGTON | ||||||||
State: | IA | ||||||||
PostalCode: | 523531238 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3196536526 | ||||||||
FaxNumber: | 3196532216 | ||||||||
Practice Location | |||||||||
Address1: | 601 E POLK ST | ||||||||
Address2: |   | ||||||||
City: | WASHINGTON | ||||||||
State: | IA | ||||||||
PostalCode: | 523531238 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3196536526 | ||||||||
FaxNumber: | 3196532216 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/24/2005 | ||||||||
LastUpdateDate: | 08/22/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | TOWNSEND | ||||||||
AuthorizedOfficialFirstName: | BRONWYN | ||||||||
AuthorizedOfficialMiddleName: | MAUREEN | ||||||||
AuthorizedOfficialTitleorPosition: | CARE PLAN COORDINATOR | ||||||||
AuthorizedOfficialTelephone: | 3196536526 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | MS. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | R.N. | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 313M00000X | 920146 | IA | X |   | Nursing & Custodial Care Facilities | Nursing Facility/Intermediate Care Facility |   | 311500000X | 920146 | IA | X |   | Nursing & Custodial Care Facilities | Alzheimer Center (Dementia Center) |   | 314000000X | 920146 | IA | X |   | Nursing & Custodial Care Facilities | Skilled Nursing Facility |   |
ID Information
ID | Type | State | Issuer | Description | 0809574 | 05 | IA |   | MEDICAID |