Organization
COUNTRYSIDE RETIREMENT HOME OF SIOUX CITY, IOWA
Active
Other names
Countryside Retirement Home, Inc.
Organization subpart
No
Provider details
NPI number
Authorized official
DEBBIE MENZENBERG (EXECUTIVE DIRECTOR)
(712) 276-3000
Entity
Organization
Contact information
Practice address
6120 MORNINGSIDE AVE, SIOUX CITY, IA 51106-3943
(712) 276-3000
(712) 266-2167
Mailing address
6120 MORNINGSIDE AVE, SIOUX CITY, IA 51106-3943
(712) 276-3000
(712) 266-2167
Taxonomy
Speciality
Code
Description
License number
State
311Z00000X
Custodial Care Facility
R-0370
IA
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
N-0370
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0800300
—
IA
Enumeration date
07/15/2005
Last updated
09/11/2009
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