Provider Demographics
NPI:1922091131
Name:ALGONA MANOR CARE CENTER, INC
Entity Type:Organization
Organization Name:ALGONA MANOR CARE CENTER, INC
Other - Org Name:ALGONA MANOR CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:K
Authorized Official - Last Name:JUCKETTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-223-6064
Mailing Address - Street 1:2221 E MCGREGOR ST
Mailing Address - Street 2:
Mailing Address - City:ALGONA
Mailing Address - State:IA
Mailing Address - Zip Code:50511-3006
Mailing Address - Country:US
Mailing Address - Phone:515-295-3505
Mailing Address - Fax:515-295-5603
Practice Address - Street 1:2221 E MCGREGOR ST
Practice Address - Street 2:
Practice Address - City:ALGONA
Practice Address - State:IA
Practice Address - Zip Code:50511-3006
Practice Address - Country:US
Practice Address - Phone:515-295-3505
Practice Address - Fax:515-295-5603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-24
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA550274314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0805002Medicaid
IA0805002Medicaid