Manor Care of Davenport Ia, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

820400 Issued in IA

Legal business name

MANOR CARE OF DAVENPORT IA, LLC

Doing business as

ManorCare Health Services

Practice address

815 E Locust St
Davenport, IA 52803-4345

Phone

(563) 324-3276

Fax

(563) 324-8844

NPI assigned

Jun 3, 2006

Last updated

Apr 6, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Martin D Allen

Title

Director

Phone

(419) 252-5734

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• ManorCare Health Services Doing business as

Electronic endpoints 1

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

{
    "created_epoch": "1149292800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1680739200000",
    "number": "1760420798",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "333 N SUMMIT ST",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436042615",
            "telephone_number": "419-252-5500",
            "fax_number": "877-385-9446"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "815 E LOCUST ST",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528034345",
            "telephone_number": "563-324-3276",
            "fax_number": "563-324-8844"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MANOR CARE OF DAVENPORT IA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-03",
        "last_updated": "2023-04-06",
        "certification_date": "2023-04-06",
        "status": "A",
        "authorized_official_last_name": "ALLEN",
        "authorized_official_first_name": "MARTIN",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "419-252-5734",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "IA",
            "license": "820400",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0800002",
            "state": "IA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.667.2",
            "affiliationName": "Ability Network",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "100 N St 6th #900a",
            "city": "Minneapolis",
            "state": "MN",
            "country_code": "US",
            "postal_code": "55403",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "ManorCare Health Services",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "ManorCare Health Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Dennis P. Malik, D.C.
• Daniel Malloy
• Mitchell Robert Mally, D.C.
• Dipesh Kumar Mandal, M.D.
• Jonathan Douglas Manley, FNP-C
• Manorcare Health Services, LLC (ProMedica Skilled Nursing and Rehabilitation (Utica Ridge))
• Marisa Mansfield, LISW
• Barbara A Mansholt, D.C.
• Angelita Manuel, DNP
• France B Many, ARNP

• Skilled Nursing Facility in Davenport, IA
• Providers in Davenport, IA by specialty
• Skilled Nursing Facility in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2023; 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.