Healthcare Provider Details

I. General information

NPI: 1740251990
Provider Name (Legal Business Name): GREATER REGIONAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 04/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1715 W PRAIRIE ST SUITE A
CRESTON IA
50801-1325
US

IV. Provider business mailing address

1715 W PRAIRIE ST SUITE A
CRESTON IA
50801-1325
US

V. Phone/Fax

Practice location:
  • Phone: 641-782-3528
  • Fax: 641-782-3541
Mailing address:
  • Phone: 641-782-3528
  • Fax: 641-782-3541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code315D00000X
TaxonomyInpatient Hospice
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number StateIA

VIII. Authorized Official

Name: LOUANN SNODGRASS
Title or Position: EXECUTIVE DIRECTOR
Credential: LISW
Phone: 641-782-3515