Organization
BUENA VISTA MANOR CARE CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. PATRICIA JEAN RICHARD (ADMINISTRATOR)
(712) 732-3254
Entity
Organization
Contact information
Practice address
1325 LAKE AVE, BOX 1266, STORM LAKE, IA 50588-1907
(712) 732-3254
(712) 732-1990
Mailing address
1325 LAKE AVE, BOX 1266, STORM LAKE, IA 50588-1907
(712) 732-3254
(712) 732-1990
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
0478248
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0478248
ELDERLY WAIVER RESPITE
IA
Enumeration date
04/27/2007
Last updated
08/22/2020
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