# SCOTTISH RITE PARK, INC.

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

## Provider details

- **NPI number:** 1679527840
- **Authorized official:** MR. MARK WILLIAM ALLEN (PRESIDENT)
- **Authorized official phone:** (515) 202-2010

## Contact information

- **Practice address:** 2909 WOODLAND AVE., DES MOINES, IA 50312
- **Practice address phone:** (515) 274-4614
- **Practice address fax:** (515) 274-6049
- **Mailing address:** 2909 WOODLAND AVE., DES MOINES, IA 50312
- **Mailing address phone:** (515) 274-4614
- **Mailing address fax:** (515) 274-6049

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 313M00000X | Nursing Facility/Intermediate Care Facility | 770155 | IA | Yes |

## Other

- **Enumeration date:** 05/20/2006
- **Last updated:** 09/04/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0800022 | — | IA |
| 01 | — | 16D0912082 | CLIA | IA |
| 01 | — | 770155 | IA LICENSE \# | IA |