Provider Demographics
NPI:1972599876
Name:ROSE VISTA HOME INC
Entity type:Organization
Organization Name:ROSE VISTA HOME INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASST. ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:SHERER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-647-2010
Mailing Address - Street 1:1109 NORMAL ST
Mailing Address - Street 2:P.O. BOX 6
Mailing Address - City:WOODBINE
Mailing Address - State:IA
Mailing Address - Zip Code:51579-1091
Mailing Address - Country:US
Mailing Address - Phone:712-647-2010
Mailing Address - Fax:712-647-3235
Practice Address - Street 1:1109 NORMAL ST
Practice Address - Street 2:
Practice Address - City:WOODBINE
Practice Address - State:IA
Practice Address - Zip Code:51579-1091
Practice Address - Country:US
Practice Address - Phone:712-647-2010
Practice Address - Fax:712-647-3235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-26
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAN-306314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0803510Medicaid
IA0803510Medicaid