Ahf Kentucky Iowa, Inc

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

N604 Issued in IA

Legal business name

AHF KENTUCKY IOWA, INC

Doing business as

Willow Gardens Care Center

Practice address

455 31St St
Marion, IA 52302-3723

Phone

(319) 377-7363

Fax

(319) 377-6022

NPI assigned

Dec 2, 2005

Last updated

Mar 9, 2020By 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. Mark T Haemmerle, CPA, INACTIVE

Title

President

Phone

(614) 760-7352

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• WILLOW GARDENS CARE CENTER Doing business as

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

{
    "created_epoch": "1133481600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1583712000000",
    "number": "1841274891",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5920 VENTURE DR STE 100",
            "city": "DUBLIN",
            "state": "OH",
            "postal_code": "430172236",
            "telephone_number": "614-760-7352",
            "fax_number": "614-760-7356"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "455 31ST ST",
            "city": "MARION",
            "state": "IA",
            "postal_code": "523023723",
            "telephone_number": "319-377-7363",
            "fax_number": "319-377-6022"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AHF KENTUCKY IOWA, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-02",
        "last_updated": "2020-03-09",
        "certification_date": "2020-03-09",
        "status": "A",
        "authorized_official_last_name": "HAEMMERLE",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "614-760-7352",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CPA, INACTIVE"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "IA",
            "license": "N604",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10808402",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WILLOW GARDENS CARE CENTER",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "WILLOW GARDENS CARE CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Skilled Nursing Facility in Marion, IA
• Providers in Marion, 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 Mar 9, 2020; 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.