Provider Demographics
NPI:1336100585
Name:CHEROKEE CARE LLC
Entity Type:Organization
Organization Name:CHEROKEE CARE LLC
Other - Org Name:COUNTRYSIDE ESTATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:ZIMBELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-232-9573
Mailing Address - Street 1:921 RIVERVIEW DR
Mailing Address - Street 2:
Mailing Address - City:CHEROKEE
Mailing Address - State:IA
Mailing Address - Zip Code:51012-1578
Mailing Address - Country:US
Mailing Address - Phone:712-225-5724
Mailing Address - Fax:712-225-3917
Practice Address - Street 1:921 RIVERVIEW DR
Practice Address - Street 2:
Practice Address - City:CHEROKEE
Practice Address - State:IA
Practice Address - Zip Code:51012-1578
Practice Address - Country:US
Practice Address - Phone:712-225-5724
Practice Address - Fax:712-225-3917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-29
Last Update Date:2013-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA180966314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0805143Medicaid
165425Medicare Oscar/Certification