EASTERN STAR MASONIC HOME
Skilled Nursing Facility
Boone, Iowa
Provider NPI: 1740283795
Organization Information:Organization Name: EASTERN STAR MASONIC HOME
Practice Location:
715 W 3RD ST BOONE, IA 50036 US
Tel: 515-432-5274 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:
715 W 3RD ST BOONE, IA 50036 US
Tel: 515-432-5274 Fax: --
Business Mailing Address:
,
Tel: -- Fax: --
Taxonomy:
Primary | Code | Category/Description | State | License Number |
---|---|---|---|---|
N | 314000000X | Nursing & Custodial Care Facilities Skilled Nursing Facility | IA | N-0268 |
N | 311Z00000X | Nursing & Custodial Care Facilities Custodial Care Facility | IA | R-268 |
Y | 313M00000X | Nursing & Custodial Care Facilities Nursing Facility/Intermediate Care Facility | IA | N-0268 |
Other Provider Identifiers:
Issuer | Number | State | Type |
---|---|---|---|
0890210 | IA | 05 | |
0801076 | IA | 05 |
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin