Healthcare Provider Details

I. General information

NPI: 1780879403
Provider Name (Legal Business Name): TRI STATE NURSING ENTERPRISES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 S LAKEPORT ST
SIOUX CITY IA
51106-4222
US

IV. Provider business mailing address

3100 S LAKEPORT ST
SIOUX CITY IA
51106-4222
US

V. Phone/Fax

Practice location:
  • Phone: 712-277-4442
  • Fax: 712-255-6840
Mailing address:
  • Phone: 712-277-4442
  • Fax: 712-255-6840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number StateIA

VIII. Authorized Official

Name: MRS. JENNIFER SCHNEIDERS
Title or Position: ACCOUNTANT
Credential:
Phone: 712-277-4442