Provider Demographics
NPI:1770576837
Name:RICEVILLE COMMUNITY REST HOME
Entity type:Organization
Organization Name:RICEVILLE COMMUNITY REST HOME
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:V
Authorized Official - Last Name:MULDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-985-2606
Mailing Address - Street 1:915 WOODLAND AVE
Mailing Address - Street 2:
Mailing Address - City:RICEVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:50466-7507
Mailing Address - Country:US
Mailing Address - Phone:641-985-2606
Mailing Address - Fax:641-985-4070
Practice Address - Street 1:915 WOODLAND AVE
Practice Address - Street 2:
Practice Address - City:RICEVILLE
Practice Address - State:IA
Practice Address - Zip Code:50466-7507
Practice Address - Country:US
Practice Address - Phone:641-985-2606
Practice Address - Fax:641-985-4070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-24
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0261314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0803395Medicaid
165541Medicare Oscar/Certification