Provider Demographics
NPI:1669468591
Name:BURLINGTON CARE CENTER, INC.
Entity Type:Organization
Organization Name:BURLINGTON CARE CENTER, INC.
Other - Org Name:BURLINGTON CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:D
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-223-6064
Mailing Address - Street 1:2610 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52601-6610
Mailing Address - Country:US
Mailing Address - Phone:319-753-2841
Mailing Address - Fax:319-758-1102
Practice Address - Street 1:2610 S 5TH ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52601-6610
Practice Address - Country:US
Practice Address - Phone:319-753-2841
Practice Address - Fax:319-758-1102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-26
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAN249313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0800391Medicaid
IA0800391Medicaid