Active NPI
Eastern Star Masonic Home
- Custodial Care Facility
- Boone, IA
National Provider Identifier
1619046596
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Custodial Care Facility
- License
- R-268
- Legal business name
- EASTERN STAR MASONIC HOME
- Practice address
- 715 W Mamie Eisenhower Ave
Boone, IA 50036-3930 - Phone
- (515) 432-5274
- Fax
- (515) 432-5276
- NPI assigned
- Nov 7, 2006
- Last updated
- Jan 27, 2025
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Scott Dylan Armstrong
- Title
- Director of Compliance
- Phone
- (515) 709-4398
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Custodial Care Facility | 311Z00000X | R-268 | IA | Primary |
Addresses
Primary practice location
715 W Mamie Eisenhower Ave
Boone, IA 50036-3930
Mailing address
715 W Mamie Eisenhower Ave
Boone, IA 50036-3930
Phone (515) 432-5274
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0890210 | Medicaid | IA | |
| X000298224 | Medicaid | IA |
National Provider Directory
National Provider Directory- Tax ID family
- Eastern Star Masonic Home
Other organizations with this tax ID 2
Organizations that report the same tax identification number in the National Provider Directory.
-
- Skilled Nursing Facility
- Boone, IA
- NPI 1740283795
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162857600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1737936000000",
"number": "1619046596",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "715 W MAMIE EISENHOWER AVE",
"city": "BOONE",
"state": "IA",
"postal_code": "500363930",
"telephone_number": "515-432-5274",
"fax_number": "515-432-5276"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "715 W MAMIE EISENHOWER AVE",
"city": "BOONE",
"state": "IA",
"postal_code": "500363930",
"telephone_number": "515-432-5274",
"fax_number": "515-432-5276"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "EASTERN STAR MASONIC HOME",
"organizational_subpart": "NO",
"enumeration_date": "2006-11-07",
"last_updated": "2025-01-27",
"certification_date": "2025-01-27",
"status": "A",
"authorized_official_last_name": "ARMSTRONG",
"authorized_official_first_name": "SCOTT",
"authorized_official_middle_name": "DYLAN",
"authorized_official_title_or_position": "DIRECTOR OF COMPLIANCE",
"authorized_official_telephone_number": "515-709-4398"
},
"taxonomies": [
{
"code": "311Z00000X",
"taxonomy_group": "",
"desc": "Custodial Care Facility",
"state": "IA",
"license": "R-268",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0890210",
"state": "IA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "X000298224",
"state": "IA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Boone, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.