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NPI Code Detail

MEDICARE: COUNTRYSIDE RETIREMENT HOME OF SIOUX CITY, IOWA

MEDICARE: COUNTRYSIDE RETIREMENT HOME OF SIOUX CITY, IOWA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1311Z00000XCustodial Care FacilityR-0370IA
2313M00000XNursing Facility/Intermediate Care FacilityN-0370IA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1104825876
Entity Type Code : Organization
Provider Name (Legal Business Name) : COUNTRYSIDE RETIREMENT HOME OF SIOUX CITY, IOWA
Provider Business Mailing Address
First Line : 6120 MORNINGSIDE AVE
Second Line :
City : SIOUX CITY
State : IA
Zip : 51106-3943
Country : US
Telephone Number : 712-276-3000
Fax Number : 712-266-2167
Provider Business Practice Location Address
First Line : 6120 MORNINGSIDE AVE
Second Line :
City : SIOUX CITY
State : IA
Zip : 51106-3943
Country : US
Telephone Number : 712-276-3000
Fax Number : 712-266-2167
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : DEBBIE MENZENBERG
Credential :
Telephone Number : 712-276-3000
Provider Enumeration Date : 07/15/2005
Last Update Date : 09/11/2009

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Directions to “COUNTRYSIDE RETIREMENT HOME OF SIOUX CITY, IOWA ” Practice Location

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