MEDICARE: COUNTY OF DUBUQUE

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
1	314000000X	Skilled Nursing Facility	310304	IA
2	315P00000X	Intellectual Disabilities Intermediate Care Facility	IMR-304	IA
3	311Z00000X	Custodial Care Facility	310304	IA
4	313M00000X	Nursing Facility/Intermediate Care Facility	310304	IA

Other Identifiers

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

General Provider Information

NPI Number	:	1215934955
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COUNTY OF DUBUQUE

Provider Business Mailing Address
First Line	:	2375 ROOSEVELT ST
Second Line	:
City	:	DUBUQUE
State	:	IA
Zip	:	52001-1479
Country	:	US
Telephone Number	:	563-583-1781
Fax Number	:	563-583-1705

Provider Business Practice Location Address
First Line	:	2375 ROOSEVELT ST
Second Line	:
City	:	DUBUQUE
State	:	IA
Zip	:	52001-1479
Country	:	US
Telephone Number	:	563-583-1781
Fax Number	:	563-583-1705

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MS. CATHRYN M. HEDLEY
Credential	:	NURSING HOME ADMINIS
Telephone Number	:	563-583-1781

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	11/01/2011

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Directions to “COUNTY OF DUBUQUE ” Practice Location

Language	Start Address	Practice Location

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