Provider Demographics
NPI:1508855271
Name:HOLY SPIRIT RETIREMENT HOME INC
Entity Type:Organization
Organization Name:HOLY SPIRIT RETIREMENT HOME INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:TOMSCHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-252-2726
Mailing Address - Street 1:1701 W 25TH ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51103-1705
Mailing Address - Country:US
Mailing Address - Phone:712-252-2726
Mailing Address - Fax:
Practice Address - Street 1:1701 W 25TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51103-1705
Practice Address - Country:US
Practice Address - Phone:712-252-2726
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-17
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0145314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0801994Medicaid
IA0801994Medicaid
IA165266Medicare Oscar/Certification