Organization
BUENA VISTA MANOR, INC.
Active
Other names
Buena Vista Manor Care Center Inc.
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
(712) 732-3254
(712) 732-1990
Mailing address
1325 LAKE AVE, STORM LAKE, IA 50588-1907
(712) 732-3254
(712) 732-1990
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
110129
IA
314000000X
Skilled Nursing Facility
Primary
165596
IA
385H00000X
Respite Care
0478248
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0800383
—
IA
01
—
16E051
FEDERAL PROVIDER #
IA
01
—
16E051
FEDERAL SURVEY
—
Enumeration date
09/26/2005
Last updated
07/20/2011
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