Healthcare Provider Details

I. General information

NPI: 1952307472
Provider Name (Legal Business Name): COMMUNITY NURSING HOME INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 01/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 N HILTON
CLARKSVILLE IA
50619-7936
US

IV. Provider business mailing address

115 N HILTON
CLARKSVILLE IA
50619-7936
US

V. Phone/Fax

Practice location:
  • Phone: 319-278-4900
  • Fax: 319-278-4166
Mailing address:
  • Phone: 319-278-4900
  • Fax: 319-278-4166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number120205
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number120205
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number120205
License Number StateIA

VIII. Authorized Official

Name: HENRY J MENNENGA
Title or Position: VICE PRESIDENT
Credential:
Phone: 319-278-4900