Organization
EDENCREST AT BEAVERDALE
Active
Parent organization
BEAVERDALE SENIOR LIVING, LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
BEAVERDALE SENIOR LIVING, LLC
Authorized official
MR. SAM PATTERSON (MANAGER)
(515) 777-5105
Entity
Organization
Contact information
Practice address
3410 BEAVER AVE, DES MOINES, IA 50310-3271
(515) 777-5105
(515) 777-1969
Mailing address
3410 BEAVER AVE, DES MOINES, IA 50310-3271
(515) 777-5105
(515) 777-1969
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
S0369
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
S0369
IOWA DEPARTMENT OF INSPECTIONS AND APPEALS
IA
Enumeration date
12/06/2017
Last updated
06/16/2018
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