Provider Demographics
NPI:1902928633
Name:SIOUX CENTER COMMUNITY HOSPITAL & HEALTH CENTER
Entity Type:Organization
Organization Name:SIOUX CENTER COMMUNITY HOSPITAL & HEALTH CENTER
Other - Org Name:FRANKEN MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:J
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-722-8153
Mailing Address - Street 1:605 SOUTH MAIN AVENUE
Mailing Address - Street 2:
Mailing Address - City:SIOUX CENTER
Mailing Address - State:IA
Mailing Address - Zip Code:51250-1398
Mailing Address - Country:US
Mailing Address - Phone:712-722-1271
Mailing Address - Fax:712-722-1003
Practice Address - Street 1:527 SOUTH MAIN AVENUE
Practice Address - Street 2:
Practice Address - City:SIOUX CENTER
Practice Address - State:IA
Practice Address - Zip Code:51250-1450
Practice Address - Country:US
Practice Address - Phone:712-722-1271
Practice Address - Fax:712-722-1003
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SIOUX CENTER COMMUNITY HOSPITAL & HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-04
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA310400000X
IACENT. NO. 50076310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0224030Medicaid