MEDICARE: CHAUTAUQUA GUEST HOMES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	340392	IA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	0443570003	OTHER	IA	CIGNA MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	65019	OTHER	IA	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538161971
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHAUTAUQUA GUEST HOMES, INC.

Provider Business Mailing Address
First Line	:	602 11TH ST
Second Line	:
City	:	CHARLES CITY
State	:	IA
Zip	:	50616-3404
Country	:	US
Telephone Number	:	641-228-2353
Fax Number	:	641-228-5264

Provider Business Practice Location Address
First Line	:	602 11TH ST
Second Line	:
City	:	CHARLES CITY
State	:	IA
Zip	:	50616-3404
Country	:	US
Telephone Number	:	641-228-2353
Fax Number	:	641-228-5264

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. DAVID AYERS
Credential	:	LNHA
Telephone Number	:	641-228-2353

Provider Enumeration Date	:	08/15/2005
Last Update Date	:	07/18/2007

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Directions to “CHAUTAUQUA GUEST HOMES, INC. ” Practice Location

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