MEDICARE: JP SENIOR HEALTHCARE LLC

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	110129	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	:	1932495389
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JP SENIOR HEALTHCARE LLC

Provider Business Mailing Address
First Line	:	PO BOX 2246
Second Line	:
City	:	SIOUX CITY
State	:	IA
Zip	:	51104-0246
Country	:	US
Telephone Number	:	712-574-7312
Fax Number	:	712-277-8313

Provider Business Practice Location Address
First Line	:	1325 LAKE AVE
Second Line	:
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	:	CFO/OWNER
Name	:	MR. JOSEPH P DEWITT
Credential	:
Telephone Number	:	712-574-7312

Provider Enumeration Date	:	06/23/2011
Last Update Date	:	08/06/2012

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