Provider Demographics
NPI:1306189105
Name:QHC MADISON SQUARE LLC
Entity type:Organization
Organization Name:QHC MADISON SQUARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:W
Authorized Official - Last Name:VOYNA
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:515-276-3656
Mailing Address - Street 1:209 W JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:WINTERSET
Mailing Address - State:IA
Mailing Address - Zip Code:50273-1676
Mailing Address - Country:US
Mailing Address - Phone:515-462-5087
Mailing Address - Fax:515-462-9058
Practice Address - Street 1:209 W JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:WINTERSET
Practice Address - State:IA
Practice Address - Zip Code:50273-1676
Practice Address - Country:US
Practice Address - Phone:515-462-5087
Practice Address - Fax:515-462-9058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-29
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
APPLIED FOR310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility