Provider Demographics
NPI:1083738132
Name:SPURGEON MANOR, INC.
Entity Type:Organization
Organization Name:SPURGEON MANOR, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:CAHILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-992-3735
Mailing Address - Street 1:1204 LINDEN ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS CENTER
Mailing Address - State:IA
Mailing Address - Zip Code:50063-1052
Mailing Address - Country:US
Mailing Address - Phone:515-992-3735
Mailing Address - Fax:515-992-3098
Practice Address - Street 1:1204 LINDEN ST
Practice Address - Street 2:
Practice Address - City:DALLAS CENTER
Practice Address - State:IA
Practice Address - Zip Code:50063-1052
Practice Address - Country:US
Practice Address - Phone:515-992-3735
Practice Address - Fax:515-992-3098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2009-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAN-199313M00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0806133Medicaid
IA165591Medicare Oscar/Certification