MEDICARE: MARIAN HOME

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	940496	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	:	1376549972
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARIAN HOME

Provider Business Mailing Address
First Line	:	2400 6TH AVE N
Second Line	:
City	:	FORT DODGE
State	:	IA
Zip	:	50501-3541
Country	:	US
Telephone Number	:	515-576-1138
Fax Number	:	515-576-5099

Provider Business Practice Location Address
First Line	:	2400 6TH AVE N
Second Line	:
City	:	FORT DODGE
State	:	IA
Zip	:	50501-3541
Country	:	US
Telephone Number	:	515-576-1138
Fax Number	:	515-576-5099

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	GERALD J BRUENING
Credential	:
Telephone Number	:	515-576-5099

Provider Enumeration Date	:	06/28/2005
Last Update Date	:	08/22/2020

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Directions to “MARIAN HOME ” Practice Location

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