| NPI | 1053396218 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JORDAN LEE WINEINGER Administrator 641-710-2215 |
| Organization Subpart ? | No |
| Primary Taxonomy | 314000000X Skilled Nursing Facility (Licence: IA 660408) |
| Additional Taxonomies | 311Z00000X Custodial Care Facility (Licence: IA R-408) |
| 313M00000X Nursing Facility/Intermediate Care Facility (Licence: IA 660408) | |
| Enumeration Date | 2005-12-09 |
| Last Update Date | 2011-12-08 |