=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336131135
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CARROLL AREA NURSING SERVICE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/17/2005
-----------------------------------------------------
Last Update Date | 06/30/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 603 W 8TH ST
-----------------------------------------------------
City | CARROLL
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 51401-2209
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 712-792-1111
-----------------------------------------------------
Fax | 712-792-8068
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 683
-----------------------------------------------------
City | CARROLL
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 51401-0683
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 712-792-1111
-----------------------------------------------------
Fax | 712-792-8068
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MS. LORETTA M BIERL
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 712-792-1111
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------