Provider Demographics
NPI:1861258428
Name:BIRKWOOD VILLAGE OF TAMA-TOLEDO, LLC
Entity type:Organization
Organization Name:BIRKWOOD VILLAGE OF TAMA-TOLEDO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLTKAMP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-594-1062
Mailing Address - Street 1:308 2ND AVENUE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:IA
Mailing Address - Zip Code:52342
Mailing Address - Country:US
Mailing Address - Phone:641-481-7047
Mailing Address - Fax:641-481-7778
Practice Address - Street 1:308 2ND AVENUE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:IA
Practice Address - Zip Code:52342
Practice Address - Country:US
Practice Address - Phone:641-481-7047
Practice Address - Fax:641-481-7778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-22
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility