Provider Demographics
NPI:1578559936
Name:OSSIAN SENIOR HOSPICE INCORPORATED
Entity Type:Organization
Organization Name:OSSIAN SENIOR HOSPICE INCORPORATED
Other - Org Name:OSSIAN SENIOR HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MELVIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:ELSBERND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-532-9440
Mailing Address - Street 1:BOX 98
Mailing Address - Street 2:
Mailing Address - City:OSSIAN
Mailing Address - State:IA
Mailing Address - Zip Code:52161-0098
Mailing Address - Country:US
Mailing Address - Phone:563-532-9440
Mailing Address - Fax:563-532-9441
Practice Address - Street 1:114 FISHER AVE
Practice Address - Street 2:
Practice Address - City:OSSIAN
Practice Address - State:IA
Practice Address - Zip Code:52161-8108
Practice Address - Country:US
Practice Address - Phone:563-532-9440
Practice Address - Fax:563-532-9441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-21
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA960404314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0803049Medicaid
IA165576Medicare Oscar/Certification