Organization
LONGHOUSE-NORTHSHIRE, LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVE W SOUCEK (ASST ADM)
(712) 262-2344
Entity
Organization
Contact information
Practice address
711 W 11TH ST, SPENCER, IA 51301-3237
(712) 262-2344
(712) 262-3550
Mailing address
711 W 11TH ST, SPENCER, IA 51301-3237
(712) 262-2344
(712) 262-3550
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
210065
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0450965
—
IA
Enumeration date
05/16/2007
Last updated
08/22/2020
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