Provider Demographics
NPI:1518956895
Name:NORTHEAST IOWA CHRISTIAN RETIREMENT COMMUNITY
Entity Type:Organization
Organization Name:NORTHEAST IOWA CHRISTIAN RETIREMENT COMMUNITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACTING ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MEYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-933-6037
Mailing Address - Street 1:313 ELKADER ST
Mailing Address - Street 2:
Mailing Address - City:STRAWBERRY POINT
Mailing Address - State:IA
Mailing Address - Zip Code:52076-9427
Mailing Address - Country:US
Mailing Address - Phone:563-933-6037
Mailing Address - Fax:563-933-2204
Practice Address - Street 1:313 ELKADER ST
Practice Address - Street 2:
Practice Address - City:STRAWBERRY POINT
Practice Address - State:IA
Practice Address - Zip Code:52076-9427
Practice Address - Country:US
Practice Address - Phone:563-933-6037
Practice Address - Fax:563-933-2204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA220344314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0802314Medicaid
IA0802314Medicaid