# COTTAGE GROVE PLACE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1366421281
- **Authorized official:** WILLIAM C. JACOBSON (BOARD CHAIR)
- **Authorized official phone:** (319) 363-2420

## Contact information

- **Practice address:** 2115 1ST AVE SE, CEDAR RAPIDS, IA 52402
- **Practice address phone:** (319) 363-2420
- **Practice address fax:** (319) 297-5646
- **Mailing address:** 2115 1ST AVE SE, CEDAR RAPIDS, IA 52402-6353
- **Mailing address phone:** (319) 363-2420
- **Mailing address fax:** (319) 297-5646

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 313M00000X | Nursing Facility/Intermediate Care Facility | 570783 | IA | Yes |

## Other

- **Enumeration date:** 01/10/2006
- **Last updated:** 08/28/2019