Provider Demographics
NPI:1831178821
Name:LONE TREE HEALTH CARE CENTER INC.
Entity type:Organization
Organization Name:LONE TREE HEALTH CARE CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DARYL
Authorized Official - Middle Name:
Authorized Official - Last Name:DUSHARM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-629-4255
Mailing Address - Street 1:501 E PIONEER ROAD
Mailing Address - Street 2:
Mailing Address - City:LONE TREE
Mailing Address - State:IA
Mailing Address - Zip Code:52755-7721
Mailing Address - Country:US
Mailing Address - Phone:319-529-4255
Mailing Address - Fax:319-629-4505
Practice Address - Street 1:501 E PIONEER ROAD
Practice Address - Street 2:
Practice Address - City:LONE TREE
Practice Address - State:IA
Practice Address - Zip Code:52755-7721
Practice Address - Country:US
Practice Address - Phone:319-629-4255
Practice Address - Fax:319-629-4505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-10
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAN0118314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0802256Medicaid
IA165388Medicare Oscar/Certification