Healthcare Provider Details

I. General information

NPI: 1568571354
Provider Name (Legal Business Name): STANTON HEALTH CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 HALLAND AVE
STANTON IA
51573-0430
US

IV. Provider business mailing address

PO BOX 430
STANTON IA
51573-0430
US

V. Phone/Fax

Practice location:
  • Phone: 712-829-2727
  • Fax: 712-829-2726
Mailing address:
  • Phone: 712-829-2727
  • Fax: 712-829-2726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberN-828
License Number StateIA

VII. Legacy identifiers

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

# 1
Identifier808873
Identifier TypeMEDICAID
Identifier StateIA
Identifier Issuer

VIII. Authorized Official

Name: JACK DEAN VETTER
Title or Position: PRESIDENT
Credential:
Phone: 402-895-3932