Provider Demographics
NPI:1760672398
Name:PAGE CARE FACILITY
Entity Type:Organization
Organization Name:PAGE CARE FACILITY
Other - Org Name:TERRACE VIEW RESIDENTIAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:J
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-542-3530
Mailing Address - Street 1:1020 W STATE ST
Mailing Address - Street 2:
Mailing Address - City:CLARINDA
Mailing Address - State:IA
Mailing Address - Zip Code:51632-1300
Mailing Address - Country:US
Mailing Address - Phone:712-542-3530
Mailing Address - Fax:712-542-2779
Practice Address - Street 1:1020 W STATE ST
Practice Address - Street 2:
Practice Address - City:CLARINDA
Practice Address - State:IA
Practice Address - Zip Code:51632-1300
Practice Address - Country:US
Practice Address - Phone:712-542-3530
Practice Address - Fax:712-542-2779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-30
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA730943311Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0739375Medicaid