Provider Demographics
NPI:1497740443
Name:METH WICK COMMUNITY
Entity Type:Organization
Organization Name:METH WICK COMMUNITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHMITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-365-9171
Mailing Address - Street 1:1224 13TH ST NW
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52405-2404
Mailing Address - Country:US
Mailing Address - Phone:319-365-9171
Mailing Address - Fax:319-364-5033
Practice Address - Street 1:1224 13TH ST NW
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52405-2404
Practice Address - Country:US
Practice Address - Phone:319-365-9171
Practice Address - Fax:319-364-5033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-15
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA165542314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0802678Medicaid
IA65542OtherBLUE CROSS BLUE SHEILD
IA0802678Medicaid