Provider Demographics
NPI:1780879403
Name:TRI STATE NURSING ENTERPRISES INC
Entity type:Organization
Organization Name:TRI STATE NURSING ENTERPRISES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHNEIDERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-277-4442
Mailing Address - Street 1:3100 S LAKEPORT ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51106-4222
Mailing Address - Country:US
Mailing Address - Phone:712-277-4442
Mailing Address - Fax:712-255-6840
Practice Address - Street 1:3100 S LAKEPORT ST
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51106-4222
Practice Address - Country:US
Practice Address - Phone:712-277-4442
Practice Address - Fax:712-255-6840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI21769Medicare PIN
IAI4863Medicare PIN