Provider Demographics
NPI:1538161971
Name:CHAUTAUQUA GUEST HOMES, INC.
Entity type:Organization
Organization Name:CHAUTAUQUA GUEST HOMES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:AYERS
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:641-228-2353
Mailing Address - Street 1:602 11TH ST
Mailing Address - Street 2:
Mailing Address - City:CHARLES CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50616-3404
Mailing Address - Country:US
Mailing Address - Phone:641-228-2353
Mailing Address - Fax:641-228-5264
Practice Address - Street 1:602 11TH ST
Practice Address - Street 2:
Practice Address - City:CHARLES CITY
Practice Address - State:IA
Practice Address - Zip Code:50616-3404
Practice Address - Country:US
Practice Address - Phone:641-228-2353
Practice Address - Fax:641-228-5264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-15
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA340392314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA65019OtherBCBS
IA0800565Medicaid
IA0443570003OtherCIGNA MEDICARE
IA0215608Medicaid
IA0215608Medicaid