COUNTRYSIDE RETIREMENT HOME OF SIOUX CITY, IOWA
Custodial Care Facility
Sioux City, Iowa
Provider NPI: 1104825876
Organization Information:Organization Name: COUNTRYSIDE RETIREMENT HOME OF SIOUX CITY, IOWA
Practice Location:
6120 MORNINGSIDE AVE SIOUX CITY, IA 51106 US
Tel: 712-276-3000 Fax: --
Business Mailing Address:
,
Tel: -- Fax: --
Taxonomy:
Other Provider Identifiers:
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin
Practice Location:
6120 MORNINGSIDE AVE SIOUX CITY, IA 51106 US
Tel: 712-276-3000 Fax: --
Business Mailing Address:
,
Tel: -- Fax: --
Taxonomy:
Primary | Code | Category/Description | State | License Number |
---|---|---|---|---|
N | 311Z00000X | Nursing & Custodial Care Facilities Custodial Care Facility | IA | R-0370 |
Y | 313M00000X | Nursing & Custodial Care Facilities Nursing Facility/Intermediate Care Facility | IA | N-0370 |
Other Provider Identifiers:
Issuer | Number | State | Type |
---|---|---|---|
0800300 | IA | 05 |
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin