Provider Demographics
NPI:1952307472
Name:COMMUNITY NURSING HOME INC
Entity Type:Organization
Organization Name:COMMUNITY NURSING HOME INC
Other - Org Name:COMMUNITY NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:J
Authorized Official - Last Name:MENNENGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-278-4900
Mailing Address - Street 1:115 N HILTON
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:50619-7936
Mailing Address - Country:US
Mailing Address - Phone:319-278-4900
Mailing Address - Fax:319-278-4166
Practice Address - Street 1:115 N HILTON
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:IA
Practice Address - Zip Code:50619-7936
Practice Address - Country:US
Practice Address - Phone:319-278-4900
Practice Address - Fax:319-278-4166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-21
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA120205314000000X, 332U00000X, 385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No332U00000XSuppliersHome Delivered Meals
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0800821Medicaid
IA0790030Medicaid
IA0800821Medicaid