Provider Demographics
NPI:1093740664
Name:SEYMOUR COMMUNITY CARE CENTER INC
Entity Type:Organization
Organization Name:SEYMOUR COMMUNITY CARE CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CLARICE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-673-6886
Mailing Address - Street 1:914 N 12TH ST
Mailing Address - Street 2:
Mailing Address - City:OSKALOOSA
Mailing Address - State:IA
Mailing Address - Zip Code:52577-2416
Mailing Address - Country:US
Mailing Address - Phone:641-673-4501
Mailing Address - Fax:641-672-2522
Practice Address - Street 1:400 E FOUR ST
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:IA
Practice Address - Zip Code:52590-1227
Practice Address - Country:US
Practice Address - Phone:641-673-4501
Practice Address - Fax:641-672-2522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0181314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0809590Medicaid
IA0431650OtherRESPITE CARE
IA0431650OtherRESPITE CARE