| NPI | 1912998741 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY GROSS Administrator 712-563-2651 |
| Organization Subpart ? | No |
| Primary Taxonomy | 314000000X Skilled Nursing Facility (Licence: IA 165232) |
| Additional Taxonomies | 311Z00000X Custodial Care Facility (Licence: IA 0890160) |
| 313M00000X Nursing Facility/Intermediate Care Facility (Licence: IA 0801316) | |
| Enumeration Date | 2005-11-01 |
| Last Update Date | 2020-08-22 |