Country Meadow Place LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

S0004 Issued in IA

Legal business name

COUNTRY MEADOW PLACE LLC

Practice address

17396 Kingbird Ave
Mason City, IA 50401-9251

Phone

(641) 423-7722

NPI assigned

Nov 7, 2006

Last updated

Dec 26, 2013By 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

Nicole Bown

Title

Controller

Phone

(319) 363-6105

Specialties & licenses 1

Addresses

Other names 1

• Willow Pointe Residences LLC Former legal business name

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

{
    "created_epoch": "1162857600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1388016000000",
    "number": "1912076332",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17396 KINGBIRD AVE",
            "city": "MASON CITY",
            "state": "IA",
            "postal_code": "504019251"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17396 KINGBIRD AVE",
            "city": "MASON CITY",
            "state": "IA",
            "postal_code": "504019251",
            "telephone_number": "641-423-7722"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTRY MEADOW PLACE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-07",
        "last_updated": "2013-12-26",
        "status": "A",
        "authorized_official_last_name": "BOWN",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_title_or_position": "CONTROLLER",
        "authorized_official_telephone_number": "319-363-6105"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "IA",
            "license": "S0004",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Willow Pointe Residences LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Assisted Living Facility in Mason City, IA
• Providers in Mason City, IA by specialty
• Assisted Living Facility in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 26, 2013; 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.