Organization
CCRC OF ALTOONA LLC
Active
Other names
Prairie Vista Village
Organization subpart
No
Provider details
NPI number
Authorized official
SCOTT E GULLEDGE (MANAGER)
(913) 890-4782
Entity
Organization
Contact information
Practice address
2785 1ST AVE S, ALTOONA, IA 50009-8820
(515) 967-8700
(515) 967-6032
Mailing address
11827 W 112TH ST, STE 103, OVERLAND PARK, KS 66210-2726
(913) 890-4782
(913) 956-6564
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0800115
—
IA
Enumeration date
10/21/2013
Last updated
03/18/2015
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