Dave'S Place LLC
Organization Active NPI Mental Illness Intermediate Care Facility · Keokuk, IA
NPI 1366740268 · NPPES record last updated Sep 15, 2023
Key facts
- NPI
- 1366740268
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Mental Illness Intermediate Care Facility 310500000X
- Legal business name
- DAVE'S PLACE LLC
- Practice address
- 3140 Plank Rd
Keokuk, IA 52632-2312 - Phone
- (319) 524-1800
- NPI assigned
- Mar 2, 2011
- Organization subpart
- No
Authorized official
- Name
- Mr. Michael Blume, LNHA, ALMC, LBSW, BS
- Title
- Administrator
- Phone
- (319) 524-1800
Owners & managing parties with NPI records 1
Corporate family (same tax ID) 1
Facilities with the same owner 1
Medicare Care Compare: Nursing home
- Listed as
- Southeast Iowa Healthcare Center
- Overall star rating
- ★★★★☆ 4 of 5
- Health inspections
- ★★☆☆☆ 2 of 5
- Staffing
- ★★★★★ 5 of 5
- Quality measures
- ★★★★★ 5 of 5
- Type
- Medicare and Medicaid
- Ownership
- For profit - Limited Liability company
- Certified
- Nov 2, 2023
- Medicare certification status
- Active
- Certified beds
- 55 · 49.1 residents per day on average
- Penalties (3 years)
- 1 · fines totaling $25,495
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IA
Skilled nursing facility certification: CCN 165797
- Legal name
- DAVES PLACE LLC
- Doing business as
- SOUTHEAST IOWA HEALTHCARE CENTER
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Nov 2, 2023
- Last certification
- Dec 5, 2024
- Beds
- 55
- Ownership / control type
- Limited Liability Corporation
- Organization structure
- LLC · Proprietary
- Enrollment address
- 3140 Plank Rd
Keokuk, IA 52632-2312 - Nursing home name
- SOUTHEAST IOWA HEALTHCARE CENTER
All disclosed owners & managing parties 10
| Name | Role | Since | Share |
|---|---|---|---|
| Michael Blume |
Operational/Managerial Control | Apr 1, 2023 | |
| Adp of the SNF | Apr 1, 2023 | ||
| Emily Smith |
Operational/Managerial Control | Mar 18, 2024 | |
| Lexington Square Irrevocable Trust |
5% Or Greater Direct Ownership Interest | Apr 7, 2017 | 100% |
| Operational/Managerial Control | Apr 7, 2017 | 100% | |
| David Israel |
Managing Control - Governing Body |
Aug 12, 2025 | |
| Murray Stanley |
Operational/Managerial Control | Apr 7, 2017 | |
| Trustee of the SNF | Apr 1, 2017 | ||
| Adp of the SNF | Apr 1, 2017 | ||
| Bell Bank Arrowhead Office |
5% Or Greater Mortgage Interest | Jun 15, 2022 | 66% |
| Paige Peterson |
Trustee of the SNF | Apr 7, 2022 | |
| Halley C Anderson |
Adp of the SNF | Oct 18, 2023 | |
| Heather Hoskins |
Operational/Managerial Control | Mar 15, 2011 | |
| Adp of the SNF | Mar 15, 2011 | ||
| Terri Abell |
Operational/Managerial Control | Jan 1, 2016 | |
| Adp of the SNF | Jan 1, 2016 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20231030003658 | IA | Part a Provider - Skilled Nursing Facility | 2264693985 | Practice locations: Keokuk, IA |
National Provider Directory
- Tax ID family
- Dave'S Place
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Illness Intermediate Care Facility | 310500000X | IA | Yes |
Addresses
Primary practice location
3140 Plank Rd
Keokuk, IA 52632-2312
Mailing address
3140 Plank Rd
Keokuk, IA 52632-2312
Phone (319) 524-1629
Other providers in Keokuk, IA
- Community Health Centers of Southeastern Iowa, Inc
- Counseling Associates, Inc
- Heather Jo Curtis
- Nick John Daskalos
- Dave'S Place
- Craig R Davenport
- Amanda Day
- Alyssa Hope Devericks
- Kelsey Dickens
- Thomas Edward Dittmer
All providers in Keokuk, IA · Mental Illness Intermediate Care Facility in Iowa
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 15, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.