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NPI Code Detail

MEDICARE: BUENA VISTA MANOR CARE CENTER

MEDICARE: BUENA VISTA MANOR CARE CENTER
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
1251E00000XHome Health Agency0478248IA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10478248OTHERIAELDERLY WAIVER RESPITE

General Provider Information

NPI Number : 1689894958
Entity Type Code : Organization
Provider Name (Legal Business Name) : BUENA VISTA MANOR CARE CENTER
Provider Business Mailing Address
First Line : 1325 LAKE AVE
Second Line : BOX 1266
City : STORM LAKE
State : IA
Zip : 50588-1907
Country : US
Telephone Number : 712-732-3254
Fax Number : 712-732-1990
Provider Business Practice Location Address
First Line : 1325 LAKE AVE
Second Line : BOX 1266
City : STORM LAKE
State : IA
Zip : 50588-1907
Country : US
Telephone Number : 712-732-3254
Fax Number : 712-732-1990
Authorized Official
Title or Position : ADMINISTRATOR
Name : MS. PATRICIA JEAN RICHARD
Credential :
Telephone Number : 712-732-3254
Provider Enumeration Date : 04/27/2007
Last Update Date : 08/22/2020

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Directions to “BUENA VISTA MANOR CARE CENTER ” Practice Location

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