Provider Demographics
NPI:1093708323
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:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:AYERS
Authorized Official - Suffix:
Authorized Official - Credentials:RNBC LNHA
Authorized Official - Phone:641-228-5351
Mailing Address - Street 1:302 9TH ST
Mailing Address - Street 2:
Mailing Address - City:CHARLES CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50616-3615
Mailing Address - Country:US
Mailing Address - Phone:641-228-5351
Mailing Address - Fax:641-228-5981
Practice Address - Street 1:302 9TH ST
Practice Address - Street 2:
Practice Address - City:CHARLES CITY
Practice Address - State:IA
Practice Address - Zip Code:50616-3615
Practice Address - Country:US
Practice Address - Phone:641-228-5351
Practice Address - Fax:641-228-5351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-23
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA340164314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0166587Medicaid
IA0215533OtherWOUND CARE
IA0800557Medicaid
IA65243OtherBCBS
IA0652420Medicaid
IA0443570001OtherDMERCK-DME
IA0800557Medicaid