Organization
MONTICELLO NURSING HOME COMPANY LLC
Active
Other names
Pennington Square Assisted Living
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DONALD L CHENSVOLD (MANAGER)
(319) 362-8916
Entity
Organization
Contact information
Practice address
502 PINEHAVEN DR, MONTICELLO, IA 52310-2062
(319) 465-2013
(319) 465-3205
Mailing address
502 PINEHAVEN DR, MONTICELLO, IA 52310-2062
(319) 465-2013
(319) 465-3205
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
S0110
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0280636
—
IA
Enumeration date
04/11/2007
Last updated
08/22/2020
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