Organization
JP SENIOR HEALTHCARE LLC
Active
Other names
NORTH LAKE MANOR
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOSEPH P DEWITT (CFO/OWNER)
(712) 574-7312
Entity
Organization
Contact information
Practice address
1325 LAKE AVE, STORM LAKE, IA 50588-1907
(712) 732-3254
(712) 732-1990
Mailing address
PO BOX 2246, SIOUX CITY, IA 51104-0246
(712) 574-7312
(712) 277-8313
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
110129
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0800056
—
IA
Enumeration date
06/23/2011
Last updated
08/06/2012
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