Organization
BUENA VISTA MANOR, INC.
Active
Other names
Buena Vista Manor
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KENNETH D. CARLSON (GENERAL MANAGER)
(515) 223-6064
Entity
Organization
Contact information
Practice address
1325 LAKE AVE, STORM LAKE, IA 50588-1907
(515) 223-6064
(515) 226-1244
Mailing address
1325 LAKE AVE, STORM LAKE, IA 50588-1907
(515) 233-6064
(515) 226-1244
Taxonomy
Speciality
Code
Description
License number
State
385H00000X
Respite Care
Primary
0478248
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0478248
—
IA
Enumeration date
05/16/2007
Last updated
07/15/2011
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