Provider Demographics
NPI:1922078286
Name:PARK VIEW CARE CENTER
Entity Type:Organization
Organization Name:PARK VIEW CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:TISDEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-752-4525
Mailing Address - Street 1:715 SHOQUOQUON DR
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52601-6634
Mailing Address - Country:US
Mailing Address - Phone:319-752-4525
Mailing Address - Fax:319-752-9625
Practice Address - Street 1:715 SHOQUOQUON DR
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52601-6634
Practice Address - Country:US
Practice Address - Phone:319-752-4525
Practice Address - Fax:319-752-9625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA290250314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0804997Medicaid
IA65212OtherWELLMARK BLUE CROSS
IA0804997Medicaid