EASTERN STAR MASONIC HOME NPI 1619046596

NPI Information

  • NPI: 1619046596
  • Provider Name: EASTERN STAR MASONIC HOME
  • Classification: Custodial Care Facility - 311Z00000X
  • Entity Type: Organization
  • Address: 715 W MAMIE EISENHOWER AVE
    BOONE, IA
    ZIP 50036
  • Phone: (515) 432-5274

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NPI Details

EASTERN STAR MASONIC HOME is a custodial care facility in Boone, IA. The provider is a facility providing care that serves to assist an individual in the activities of daily living, such as assistance in walking, getting in and out of bed, bathing, dressing, feeding, and using the toilet, preparation of special diets, and supervision of medication that usually can be self-administered. Custodial care essentially is personal care that does not require the continuing attention of trained medical or paramedical personnel. EASTERN STAR MASONIC HOME NPI is 1619046596. The provider is registered as an organization entity type.

The provider's business location address is:

715 W MAMIE EISENHOWER AVE
BOONE, IA
ZIP 50036-930
Phone: (515) 432-5274
Fax: (515) 432-5276

The provider's authorized official is Scott Dylan Armstrong .
The authorized official title is Director Of Compliance and has the following contact phone number (515) 709-4398.

The enumeration date for this NPI number is 11/7/2006 and was last updated on 1/27/2025.

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
1311Z00000XCustodial Care FacilityR-268IOWAYes

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
10890210MEDICAIDIOWA
2X000298224MEDICAIDIOWA

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: 3/30/2025

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