Provider Demographics
NPI:1558356386
Name:TAMA HEALTH CARE ENTERPRISES LLC
Entity Type:Organization
Organization Name:TAMA HEALTH CARE ENTERPRISES LLC
Other - Org Name:D/B/A SUNNY HILL CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:OSTHUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-440-2177
Mailing Address - Street 1:1708 HARDING ST
Mailing Address - Street 2:
Mailing Address - City:TAMA
Mailing Address - State:IA
Mailing Address - Zip Code:52339-1028
Mailing Address - Country:US
Mailing Address - Phone:641-484-4061
Mailing Address - Fax:641-484-3103
Practice Address - Street 1:1708 HARDING ST
Practice Address - Street 2:
Practice Address - City:TAMA
Practice Address - State:IA
Practice Address - Zip Code:52339-1028
Practice Address - Country:US
Practice Address - Phone:641-484-4061
Practice Address - Fax:641-484-3103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-19
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0805481Medicaid
IA165462Medicare Oscar/Certification