Organization
COUNTRY MEADOW PLACE LLC
Active
Other names
Willow Pointe Residences LLC
Organization subpart
No
Provider details
NPI number
Authorized official
NICOLE BOWN (CONTROLLER)
(319) 363-6105
Entity
Organization
Contact information
Practice address
17396 KINGBIRD AVE, MASON CITY, IA 50401-9251
(641) 423-7722
Mailing address
17396 KINGBIRD AVE, MASON CITY, IA 50401-9251
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
S0004
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0158840
—
IA
Enumeration date
11/07/2006
Last updated
12/26/2013
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