Healthcare Provider Details

I. General information

NPI: 1467459073
Provider Name (Legal Business Name): CLARION HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2005
Last Update Date: 09/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 13TH AVE SW
CLARION IA
50525-2004
US

IV. Provider business mailing address

110 13TH AVE SW
CLARION IA
50525-2004
US

V. Phone/Fax

Practice location:
  • Phone: 515-532-2893
  • Fax: 515-532-2782
Mailing address:
  • Phone: 515-532-2893
  • Fax: 515-532-2782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number990752
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier65362
Identifier TypeOTHER
Identifier StateIA
Identifier IssuerBCBS PROVIDER#
# 2
Identifier0804914
Identifier TypeMEDICAID
Identifier StateIA
Identifier Issuer

VIII. Authorized Official

Name: MRS. STEPHANIE STEWART
Title or Position: ADMINISTRATOR
Credential:
Phone: 515-532-2893