Organization
MARIAN HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GERALD J BRUENING (ADMINISTRATOR)
(515) 576-5099
Entity
Organization
Contact information
Practice address
2400 6TH AVE N, FORT DODGE, IA 50501-3541
(515) 576-1138
(515) 576-5099
Mailing address
2400 6TH AVE N, FORT DODGE, IA 50501-3541
(515) 576-1138
(515) 576-5099
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
940496
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0802538
—
IA
Enumeration date
06/28/2005
Last updated
08/22/2020
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