Provider Demographics
NPI:1780618157
Name:MARIAN HEALTH CENTER -SMHC
Entity type:Organization
Organization Name:MARIAN HEALTH CENTER -SMHC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOLENE
Authorized Official - Middle Name:S
Authorized Official - Last Name:HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-279-2263
Mailing Address - Street 1:801 5TH ST
Mailing Address - Street 2:SIXTH CENTRAL SNF
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51101-1326
Mailing Address - Country:US
Mailing Address - Phone:712-279-2010
Mailing Address - Fax:712-279-5631
Practice Address - Street 1:801 5TH ST
Practice Address - Street 2:SIXTH CENTRAL SNF
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51101-1326
Practice Address - Country:US
Practice Address - Phone:712-279-2010
Practice Address - Fax:712-279-5631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA970112H314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA66153OtherWELLMARK BLUE CROSS
IA66153OtherWELLMARK BLUE CROSS