Provider Demographics
NPI:1336148725
Name:TITONKA COMMUNITY REST HOME, INC.
Entity Type:Organization
Organization Name:TITONKA COMMUNITY REST HOME, INC.
Other - Org Name:TITONKA CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:YOUMANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-928-2600
Mailing Address - Street 1:P.O. BOX 349
Mailing Address - Street 2:
Mailing Address - City:TITONKA
Mailing Address - State:IA
Mailing Address - Zip Code:50480-7781
Mailing Address - Country:US
Mailing Address - Phone:515-928-2600
Mailing Address - Fax:515-928-2610
Practice Address - Street 1:312 1ST AVE NW
Practice Address - Street 2:
Practice Address - City:TITONKA
Practice Address - State:IA
Practice Address - Zip Code:50480-7781
Practice Address - Country:US
Practice Address - Phone:515-928-2600
Practice Address - Fax:515-928-2610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-18
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA804005313M00000X
IA550241313M00000X, 314000000X
IA165431314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0804005Medicaid
IA804005Medicaid
IA0804005Medicaid
IA165431Medicare Oscar/Certification