1639954241 NPI number — ALGONQUIN SENIOR LIVING LEASECO, LLC

Table of content: (NPI 1639954241)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639954241 NPI number — ALGONQUIN SENIOR LIVING LEASECO, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALGONQUIN SENIOR LIVING LEASECO, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639954241
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/30/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 LOCUST ST STE 820
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DES MOINES
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50309-2334
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
515-381-7660
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2001 W ALGONQUIN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALGONQUIN
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60102-1300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-458-6800
Provider Business Practice Location Address Fax Number:
847-984-1895
Provider Enumeration Date:
08/30/2023

Additional Information

Authorized Official

Authorized Official Last Name:
NELSON
Authorized Official First Name:
JOEL
Authorized Official Middle Name:
D.
Authorized Official Title or Position:
MEMBER
Authorized Official Telephone Number:
515-875-4500

Provider Taxonomy Codes

  • Taxonomy code: 310400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com