Organization
COUNTRY LIFE HEALTH CARE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT KEITH KELLEY (ADMINISTRATOR)
(641) 673-4447
Entity
Organization
Contact information
Practice address
2554 FORD AVE, OSKALOOSA, IA 52577-8850
(641) 673-4447
(641) 673-4447
Mailing address
2554 FORD AVE, OSKALOOSA, IA 52577-8850
(641) 673-4447
(641) 673-4447
Taxonomy
Speciality
Code
Description
License number
State
311Z00000X
Custodial Care Facility
Primary
620603
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0895003
—
IA
Enumeration date
03/06/2007
Last updated
08/22/2020
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