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PENNINGTON SQUARE ASSISTED LIVING
NPI 1104049717
Assisted Living Facility in Monticello, IA

Active since April 11, 2007CLIA 16D2191626 · Waiver
502 PINEHAVEN DR, MONTICELLO, IA 52310(319) 465-2013(319) 465-3205 Get Directions Write a Review

NPPES record last updated: August 22, 2020. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Pennington Square Assisted Living NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PENNINGTON SQUARE ASSISTED LIVING (NPI 1104049717) is a healthcare organization registered as an assisted living facility in Monticello, Iowa and active in the NPI registry since April 2007. The organization holds a CLIA Waiver certificate valid through August 30, 2026 and lists Donald L Chensvold, Manager, as its authorized official.

NPPES Registry Identity

NPI1104049717
Entity TypeOrganization
Primary Taxonomy310400000X
Legal Business NameMONTICELLO NURSING HOME COMPANY LLC
Location Address502 PINEHAVEN DRMonticello, IA 52310-2062
Mailing Address502 Pinehaven DrMonticello, IA 52310-2062 · (319) 465-2013 · Fax (319) 465-3205
Phone(319) 465-2013
Fax(319) 465-3205
Organization SubpartNo
Authorized OfficialDonald L ChensvoldManager · (319) 362-8916
Enumeration DateApril 11, 2007
Last NPPES UpdateAugust 22, 2020
✔ NPI 1104049717 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyAssisted Living FacilityNursing & Custodial Care Facilities
Taxonomy Code310400000X
License✔ Licensed in IA · S0110
Definition
A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being.
502 PINEHAVEN DR, Monticello, IA 52310
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Other Names 1

Doing Business AsPennington Square Assisted Living

Other Identifiers 1

Medicaid0280636IA

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 16D2191626

Pennington Square Assisted Living · Monticello, IA
Active · expires Aug 30, 2026
CLIA Number16D2191626
Laboratory TypeAssisted Living Facility
Certificate Effective DateAugust 31, 2024
Certificate Expiration DateAugust 30, 2026
Laboratory DirectorAngelena Purdy
Laboratory Phone(319) 465-2013
Laboratory LocationPennington Square Assisted Living502 Pinehaven Dr, Monticello, IA 52310
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Monticello Nursing Home Company LLC's NPI number?

The NPI number for Monticello Nursing Home Company LLC is 1104049717. It was assigned to this organization in the NPPES registry on April 11, 2007. The provider is doing business as Pennington Square Assisted Living.

Where is Monticello Nursing Home Company LLC located?

Monticello Nursing Home Company LLC is located at 502 Pinehaven Dr, Monticello, IA 52310. The listed phone number is (319) 465-2013.

What is Monticello Nursing Home Company LLC's specialty?

The primary specialty registered for this NPI is Assisted Living Facility with taxonomy code 310400000X.

Does Monticello Nursing Home Company LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 16D2191626) is associated with this NPI, valid through August 30, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Monticello Nursing Home Company LLC was last updated on August 22, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.