Provider Demographics
NPI:1013025386
Name:COMMUNITY MEMORIAL HEALTHCENTER ASSOCIATION
Entity Type:Organization
Organization Name:COMMUNITY MEMORIAL HEALTHCENTER ASSOCIATION
Other - Org Name:COMMUNITY MEMORIAL HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:G
Authorized Official - Last Name:SCHULZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-728-2428
Mailing Address - Street 1:231 N 8TH AVE W
Mailing Address - Street 2:
Mailing Address - City:HARTLEY
Mailing Address - State:IA
Mailing Address - Zip Code:51346-1077
Mailing Address - Country:US
Mailing Address - Phone:712-728-2428
Mailing Address - Fax:712-728-2429
Practice Address - Street 1:231 N 8TH AVE W
Practice Address - Street 2:
Practice Address - City:HARTLEY
Practice Address - State:IA
Practice Address - Zip Code:51346-1077
Practice Address - Country:US
Practice Address - Phone:712-728-2428
Practice Address - Fax:712-728-2429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA710779314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0801803Medicaid
IA165177Medicare Oscar/Certification