Provider Demographics
NPI:1679396089
Name:OSCEOLA SENIOR LIVING LLC
Entity type:Organization
Organization Name:OSCEOLA SENIOR LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOE
Authorized Official - Middle Name:
Authorized Official - Last Name:HEITRITTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-754-5350
Mailing Address - Street 1:PO BOX 258
Mailing Address - Street 2:
Mailing Address - City:SIBLEY
Mailing Address - State:IA
Mailing Address - Zip Code:51249-0258
Mailing Address - Country:US
Mailing Address - Phone:712-754-2574
Mailing Address - Fax:
Practice Address - Street 1:100 CEDAR LN
Practice Address - Street 2:
Practice Address - City:SIBLEY
Practice Address - State:IA
Practice Address - Zip Code:51249-1055
Practice Address - Country:US
Practice Address - Phone:712-754-2568
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility