Apple Valley Assisted Living LLC.
Organization Active NPI Point of Service · Clear Lake, IA
NPI 1508085879 · NPPES record last updated Aug 22, 2020
Key facts
- NPI
- 1508085879
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Point of Service 305S00000X
- License
- S0166 (IA)
- Legal business name
- APPLE VALLEY ASSISTED LIVING LLC.
- Practice address
- 405 27TH Ave S
Clear Lake, IA 50428-4002 - Phone
- (641) 357-7083
- Fax
- (641) 357-1512
- NPI assigned
- Apr 25, 2007
- Organization subpart
- No
Authorized official
- Name
- Ms. Terri Ann Cosselman, R.N.
- Title
- Administrator
- Phone
- (641) 357-7083
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 16D1057376 | Apple Valley Assisted Living | Certificate of waiver | Aug 9, 2026 |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Point of Service | 305S00000X | S0166 | IA | Yes |
Addresses
Primary practice location
405 27TH Ave S
Clear Lake, IA 50428-4002
Mailing address
405 27TH Ave S
Clear Lake, IA 50428-4002
Phone (641) 357-7083
Other providers in Clear Lake, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- 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.