Provider Demographics
NPI:1215788500
Name:CALAMITY ROSE RANCH LLC
Entity type:Organization
Organization Name:CALAMITY ROSE RANCH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OF CALAMITY ROSE RANCH LLC
Authorized Official - Prefix:
Authorized Official - First Name:KAYLA
Authorized Official - Middle Name:LEA
Authorized Official - Last Name:CARLSTEN
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:563-261-4434
Mailing Address - Street 1:1612 TAYLOR AVE
Mailing Address - Street 2:
Mailing Address - City:MUSCATINE
Mailing Address - State:IA
Mailing Address - Zip Code:52761-9789
Mailing Address - Country:US
Mailing Address - Phone:563-261-4434
Mailing Address - Fax:
Practice Address - Street 1:701 ORANGE ST
Practice Address - Street 2:
Practice Address - City:MUSCATINE
Practice Address - State:IA
Practice Address - Zip Code:52761-4358
Practice Address - Country:US
Practice Address - Phone:563-261-4434
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-27
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAP10007816021Medicaid