Board of Trustees Grand Charity Fund Grand Lodge of Iowa a F & a M

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

820296 Issued in IA

Legal business name

BOARD OF TRUSTEES GRAND CHARITY FUND GRAND LODGE OF IOWA A F & A M

Practice address

2500 Grant St
Bettendorf, IA 52722-5092

Phone

(563) 359-9171

Fax

(563) 359-6900

NPI assigned

Nov 27, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Tami Tegeler

Title

Executive Director

Phone

(815) 499-7751

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Iowa Masonic Health Facilities Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164585600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1713484800000",
    "number": "1164598868",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2500 GRANT ST",
            "city": "BETTENDORF",
            "state": "IA",
            "postal_code": "527225092",
            "telephone_number": "563-359-9171",
            "fax_number": "563-359-6900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 GRANT ST",
            "city": "BETTENDORF",
            "state": "IA",
            "postal_code": "527225092",
            "telephone_number": "563-359-9171",
            "fax_number": "563-359-6900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOARD OF TRUSTEES GRAND CHARITY FUND GRAND LODGE OF IOWA A F & A M",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-27",
        "last_updated": "2024-04-19",
        "certification_date": "2024-04-19",
        "status": "A",
        "authorized_official_last_name": "TEGELER",
        "authorized_official_first_name": "TAMI",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "815-499-7751"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "IA",
            "license": "820296",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0802033",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER #",
            "identifier": "65553",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Iowa Masonic Health Facilities",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Iowa Masonic Health Facilities",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Bloom Wellness Group
• Wendy Sue Bloomhuff, DPT
• Bridget Marie Blunk, P.T.
• Joshua David Blunt, D.C., M.S.
• Beth Bly, PTA
• Julie Kay Williams Bockenstedt, PHD, LISW, LCSW
• Body Alignment Center
• Regina Charlotte Bollaert, NP
• Emily J Boswell, DPT
• Cole Bousselot, DDS

• All providers in Bettendorf, IA
• Skilled Nursing Facility in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.