Provider Demographics
NPI:1649240987
Name:GRISWOLD CARE CENTER INC.
Entity Type:Organization
Organization Name:GRISWOLD CARE CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:A
Authorized Official - Last Name:HINZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-778-2534
Mailing Address - Street 1:106 HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:GRISWOLD
Mailing Address - State:IA
Mailing Address - Zip Code:51535-8042
Mailing Address - Country:US
Mailing Address - Phone:712-778-2534
Mailing Address - Fax:712-778-2675
Practice Address - Street 1:106 HARRISON ST
Practice Address - Street 2:
Practice Address - City:GRISWOLD
Practice Address - State:IA
Practice Address - Zip Code:51535-8042
Practice Address - Country:US
Practice Address - Phone:712-778-2534
Practice Address - Fax:712-778-2675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-26
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA150033313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0807313Medicaid
IA65351OtherWELLMARK BC/BS
IA165351Medicare Oscar/Certification