Healthcare Provider Details

I. General information

NPI: 1710085626
Provider Name (Legal Business Name): TABOR MANOR CARE CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 MAIN ST
TABOR IA
51653
US

IV. Provider business mailing address

PO BOX 180 209 MAIN ST
TABOR IA
51653
US

V. Phone/Fax

Practice location:
  • Phone: 712-629-2645
  • Fax: 712-629-6665
Mailing address:
  • Phone: 712-629-2645
  • Fax: 712-629-6665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number360577
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. LEONARD B WORCESTER
Title or Position: ADMINISTRATOR
Credential:
Phone: 712-629-2645