Provider Demographics
NPI:1932161106
Name:TRIPOLI NURSING AND REHAB
Entity Type:Organization
Organization Name:TRIPOLI NURSING AND REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:SELLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-882-4269
Mailing Address - Street 1:604 3RD STREET SW
Mailing Address - Street 2:
Mailing Address - City:TRIPOLI
Mailing Address - State:IA
Mailing Address - Zip Code:50676-9614
Mailing Address - Country:US
Mailing Address - Phone:319-882-4269
Mailing Address - Fax:319-882-3511
Practice Address - Street 1:604 3RD STREET SW
Practice Address - Street 2:
Practice Address - City:TRIPOLI
Practice Address - State:IA
Practice Address - Zip Code:50676-9614
Practice Address - Country:US
Practice Address - Phone:319-882-4269
Practice Address - Fax:319-882-3511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-04
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAN-393313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA65494OtherWELLMARK BC/BS
IA0804021Medicaid
IA0804021Medicaid