Indianola Ia Assisted Living

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

S0199 Issued in IA

Legal business name

INDIANOLA IA ASSISTED LIVING

Practice address

608 South 15TH St.
Indianola, IA 50125

Phone

(515) 961-8900

Fax

(515) 961-8907

NPI assigned

May 22, 2007

Organization subpart

No

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

Authorized official

Name

Ms. Gayla Annette Gilliland, MANAGER

Title

Manager

Phone

(515) 961-8900

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Windsor Manor Assisted Living Other name

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

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

{
    "created_epoch": "1179792000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1216684800000",
    "number": "1245440221",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "608 SOUTH 15TH ST.",
            "city": "INDIANOLA",
            "state": "IA",
            "postal_code": "50125",
            "telephone_number": "515-961-8900",
            "fax_number": "515-961-8907"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "608 SOUTH 15TH ST.",
            "city": "INDIANOLA",
            "state": "IA",
            "postal_code": "50125",
            "telephone_number": "515-961-8900",
            "fax_number": "515-961-8907"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDIANOLA IA ASSISTED LIVING",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-22",
        "last_updated": "2008-07-22",
        "status": "A",
        "authorized_official_last_name": "GILLILAND",
        "authorized_official_first_name": "GAYLA",
        "authorized_official_middle_name": "ANNETTE",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "515-961-8900",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MANAGER"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "IA",
            "license": "S0199",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0476994",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Windsor Manor Assisted Living",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Assisted Living Facility in Indianola, IA
• Providers in Indianola, IA by specialty
• Assisted Living Facility in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.