Provider Demographics
NPI:1669645578
Name:SIOUXLAND PACE
Entity Type:Organization
Organization Name:SIOUXLAND PACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:KENT
Authorized Official - Last Name:SWANSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-471-9702
Mailing Address - Street 1:1200 TRI VIEW AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51103-4900
Mailing Address - Country:US
Mailing Address - Phone:712-224-7223
Mailing Address - Fax:712-224-7250
Practice Address - Street 1:1200 TRI VIEW AVE
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51103-4900
Practice Address - Country:US
Practice Address - Phone:712-224-7223
Practice Address - Fax:712-224-7250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-11
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAH8424251T00000X
IA251T00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Yes251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization