Healthcare Provider Details

I. General information

NPI: 1366442295
Provider Name (Legal Business Name): SUMNER COMMUNITY CLUB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 04/19/2023
Certification Date: 12/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 W 1ST ST
SUMNER IA
50674-1203
US

IV. Provider business mailing address

PO BOX 148
SUMNER IA
50674-0148
US

V. Phone/Fax

Practice location:
  • Phone: 563-578-3275
  • Fax: 563-578-3279
Mailing address:
  • Phone: 563-578-3275
  • Fax: 563-578-3279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: DAWN DIANE EVERDING
Title or Position: CHIEF ADMINISTRATOR/CFO
Credential: CFO
Phone: 563-578-3275