Provider Demographics
NPI:1871690289
Name:JEFFERSON COUNTY HOSPITAL
Entity Type:Organization
Organization Name:JEFFERSON COUNTY HOSPITAL
Other - Org Name:JCH LIVING CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:K
Authorized Official - Last Name:CARDIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-472-4111
Mailing Address - Street 1:400 HIGHLAND ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:IA
Mailing Address - Zip Code:52556-3713
Mailing Address - Country:US
Mailing Address - Phone:641-472-4111
Mailing Address - Fax:641-469-4375
Practice Address - Street 1:400 HIGHLAND ST
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:IA
Practice Address - Zip Code:52556-3713
Practice Address - Country:US
Practice Address - Phone:641-472-4111
Practice Address - Fax:641-469-4375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2008-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA510063H313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0809681Medicaid
IA0809681Medicaid