Provider Demographics
NPI:1942672613
Name:PARADYM HEALTH CARE INC
Entity Type:Organization
Organization Name:PARADYM HEALTH CARE INC
Other - Org Name:ROSE HAVEN NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHANE
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:SISSEL
Authorized Official - Suffix:
Authorized Official - Credentials:MSW LNHA
Authorized Official - Phone:563-260-2729
Mailing Address - Street 1:1500 FRANKLYN AVE
Mailing Address - Street 2:
Mailing Address - City:MARENGO
Mailing Address - State:IA
Mailing Address - Zip Code:52301-1312
Mailing Address - Country:US
Mailing Address - Phone:319-642-5533
Mailing Address - Fax:319-642-3822
Practice Address - Street 1:1500 FRANKLYN AVE
Practice Address - Street 2:
Practice Address - City:MARENGO
Practice Address - State:IA
Practice Address - Zip Code:52301-1312
Practice Address - Country:US
Practice Address - Phone:319-642-5533
Practice Address - Fax:319-642-3822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-21
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0800170Medicaid
IA165614Medicare Oscar/Certification