# KEOKUK AREA GROUP HOME

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

## Provider details

- **NPI number:** 1790842615
- **Authorized official:** THOMAS J JENKINS (QMRP ADMINISTRATOR)
- **Authorized official phone:** (319) 524-1871

## Contact information

- **Practice address:** 317 HIGH ST, KEOKUK, IA 52632-5939
- **Practice address phone:** (319) 524-1871
- **Practice address fax:** (319) 524-2612
- **Mailing address:** 317 HIGH ST, KEOKUK, IA 52632-5939
- **Mailing address phone:** (319) 524-1871
- **Mailing address fax:** (319) 524-2612

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 311ZA0620X | Adult Care Home Facility | 560091 | IA | Yes |

## Other

- **Enumeration date:** 01/02/2007
- **Last updated:** 08/22/2020