Provider Demographics
NPI:1780752923
Name:WEST BEND CARE CENTER
Entity type:Organization
Organization Name:WEST BEND CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-293-0117
Mailing Address - Street 1:1512 PIERCE ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51105-1246
Mailing Address - Country:US
Mailing Address - Phone:712-293-0117
Mailing Address - Fax:712-293-0356
Practice Address - Street 1:203 4TH ST NW
Practice Address - Street 2:
Practice Address - City:WEST BEND
Practice Address - State:IA
Practice Address - Zip Code:50597-5114
Practice Address - Country:US
Practice Address - Phone:515-887-4071
Practice Address - Fax:515-887-3973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA740851313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0805275Medicaid
IAF250511OtherMIDLANDS CHOICE PPO
IA65444OtherBCBS IA
IA0805275Medicaid