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SCOTTISH RITE PARK INC. NPI 1679527840


NPI Information

NPI: 1679527840
Provider Name: SCOTTISH RITE PARK, INC.
Classification: Nursing Facility/Intermediate Care Facility - 313M00000X
Entity Type: Organization

CLIA Number: 16D0912082

Address:
2909 WOODLAND AVE.
DES MOINES, IA
ZIP 50312
Phone: (515) 274-4614
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SCOTTISH RITE PARK, INC. is a nursing facility intermediate care facility in Des Moines, IA. The provider is an institution (or a distinct part of an institution) which- (1) is primarily engaged in providing to residents- (A) skilled nursing care and related services for residents who require medical or nursing care, (B) rehabilitation services for the rehabilitation of injured, disabled, or sick persons, or, on a regular basis, health-related care and services to individuals who because of their mental or physical condition require care and services (above the level of room and board) which can be made available to them only through institutional facilities, and is not primarily for the care and treatment of mental diseases; (2) has in effect a transfer agreement with one or more hospitals. SCOTTISH RITE PARK, INC. NPI is 1679527840. The provider is registered as an organization entity type.

The provider's business location address is:

2909 WOODLAND AVE.
DES MOINES, IA
ZIP 50312
Phone: (515) 274-4614
Fax: (515) 274-6049

The provider's authorized official is Mark William Allen .
The authorized official title is President and has the following contact phone number (515) 202-2010.

The CLIA number assigned to this NPI record is 16D0912082 - skilled nursing facility/nursing facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 5/20/2006 and was last updated on 9/4/2009.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1313M00000XNursing Facility/Intermediate Care Facility770155IOWAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
116D0912082OTHERIOWACLIA
2770155OTHERIOWAIA LICENSE #
30800022MEDICAIDIOWA
4165593MEDICARE OSCAR/CERTIFICATIONIOWA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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