Provider Demographics
NPI:1023090255
Name:SIGNATURE PROPERTIES OF PAULLINA LLC
Entity type:Organization
Organization Name:SIGNATURE PROPERTIES OF PAULLINA LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:MEHLHOP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-727-1768
Mailing Address - Street 1:423 N WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:PAULLINA
Mailing Address - State:IA
Mailing Address - Zip Code:51046-1003
Mailing Address - Country:US
Mailing Address - Phone:712-448-3455
Mailing Address - Fax:712-448-2283
Practice Address - Street 1:423 N WILLOW ST
Practice Address - Street 2:
Practice Address - City:PAULLINA
Practice Address - State:IA
Practice Address - Zip Code:51046-1003
Practice Address - Country:US
Practice Address - Phone:712-448-3455
Practice Address - Fax:712-448-2283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-15
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA710356314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0805069Medicaid
IA0805069Medicaid