Organization
SCOTTISH RITE PARK, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK WILLIAM ALLEN (PRESIDENT)
(515) 202-2010
Entity
Organization
Contact information
Practice address
2909 WOODLAND AVE., DES MOINES, IA 50312
(515) 274-4614
(515) 274-6049
Mailing address
2909 WOODLAND AVE., DES MOINES, IA 50312
(515) 274-4614
(515) 274-6049
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
770155
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0800022
—
IA
01
—
16D0912082
CLIA
IA
01
—
770155
IA LICENSE #
IA
Enumeration date
05/20/2006
Last updated
09/04/2009
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