Provider Demographics
NPI:1619962214
Name:WASHINGTON COUNTY HOSPITAL
Entity Type:Organization
Organization Name:WASHINGTON COUNTY HOSPITAL
Other - Org Name:MCCREEDY HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LTC ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-863-3958
Mailing Address - Street 1:400 E POLK ST
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52353-1237
Mailing Address - Country:US
Mailing Address - Phone:319-863-3958
Mailing Address - Fax:319-863-3956
Practice Address - Street 1:400 E POLK ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:IA
Practice Address - Zip Code:52353-1237
Practice Address - Country:US
Practice Address - Phone:319-863-3958
Practice Address - Fax:319-863-3956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-20
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA920052H313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA16E681Medicare UPIN