MEDICARE: S.T.L. CARE COMPANY

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	313M00000X	Nursing Facility/Intermediate Care Facility	570245	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	:	1952528424
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	S.T.L. CARE COMPANY

Provider Business Mailing Address
First Line	:	1220 5TH AVE SE
Second Line	:
City	:	CEDAR RAPIDS
State	:	IA
Zip	:	52403-4049
Country	:	US
Telephone Number	:	319-366-8701
Fax Number	:	319-366-8703

Provider Business Practice Location Address
First Line	:	1220 5TH AVE SE
Second Line	:
City	:	CEDAR RAPIDS
State	:	IA
Zip	:	52403-4049
Country	:	US
Telephone Number	:	319-366-8701
Fax Number	:	319-366-8703

Authorized Official
Title or Position	:	MANAGER
Name	:	MR. DONALD L CHENSVOLD
Credential	:
Telephone Number	:	319-362-8916

Provider Enumeration Date	:	04/19/2007
Last Update Date	:	08/22/2020

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