Provider Demographics
NPI:1366516239
Name:MADRID HOME FOR THE AGING
Entity type:Organization
Organization Name:MADRID HOME FOR THE AGING
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:
Authorized Official - First Name:KRIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-795-3007
Mailing Address - Street 1:600 N KENNEDY AVE
Mailing Address - Street 2:
Mailing Address - City:MADRID
Mailing Address - State:IA
Mailing Address - Zip Code:50156-7608
Mailing Address - Country:US
Mailing Address - Phone:515-795-4097
Mailing Address - Fax:515-795-4286
Practice Address - Street 1:600 N KENNEDY AVE
Practice Address - Street 2:
Practice Address - City:MADRID
Practice Address - State:IA
Practice Address - Zip Code:50156-7608
Practice Address - Country:US
Practice Address - Phone:515-795-4097
Practice Address - Fax:515-795-4286
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MADRID HOME FOR THE AGING
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-20
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAS0176310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0298943Medicaid