Organization
STACYVILLE COMMUNITY NURSING HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JORDAN LEE WINEINGER NHA (ADMINISTRATOR)
(641) 710-2215
Entity
Organization
Contact information
Practice address
413 S. BROAD STREET, STACYVILLE, IA 50476-5003
(641) 710-2215
(641) 710-2158
Mailing address
413 S. BROAD STREET, STACYVILLE, IA 50476-5003
(641) 710-2215
(641) 710-2158
Taxonomy
Speciality
Code
Description
License number
State
311Z00000X
Custodial Care Facility
R-408
IA
313M00000X
Nursing Facility/Intermediate Care Facility
660408
IA
314000000X
Skilled Nursing Facility
Primary
660408
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0803783
—
IA
05
—
0893107
—
IA
Enumeration date
12/09/2005
Last updated
12/08/2011
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