MEDICARE: TRI STATE NURSING ENTERPRISES 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	251J00000X	Nursing Care Agency		IA

General Provider Information

NPI Number	:	1780879403
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRI STATE NURSING ENTERPRISES INC

Provider Business Mailing Address
First Line	:	3100 S LAKEPORT ST
Second Line	:
City	:	SIOUX CITY
State	:	IA
Zip	:	51106-4222
Country	:	US
Telephone Number	:	712-277-4442
Fax Number	:	712-255-6840

Provider Business Practice Location Address
First Line	:	3100 S LAKEPORT ST
Second Line	:
City	:	SIOUX CITY
State	:	IA
Zip	:	51106-4222
Country	:	US
Telephone Number	:	712-277-4442
Fax Number	:	712-255-6840

Authorized Official
Title or Position	:	ACCOUNTANT
Name	:	MRS. JENNIFER SCHNEIDERS
Credential	:
Telephone Number	:	712-277-4442

Provider Enumeration Date	:	09/06/2007
Last Update Date	:	07/21/2022

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