Provider Demographics
NPI:1679576946
Name:THE CEDAR FOUNDATION INCORPORATED OF CEDAR COUNTY IOWA
Entity type:Organization
Organization Name:THE CEDAR FOUNDATION INCORPORATED OF CEDAR COUNTY IOWA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:M
Authorized Official - Last Name:EAST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-886-2133
Mailing Address - Street 1:1200 MULBERRY STREET
Mailing Address - Street 2:
Mailing Address - City:TIPTON
Mailing Address - State:IA
Mailing Address - Zip Code:52772-1347
Mailing Address - Country:US
Mailing Address - Phone:563-886-2133
Mailing Address - Fax:563-886-1555
Practice Address - Street 1:1200 MULBERRY STREET
Practice Address - Street 2:
Practice Address - City:TIPTON
Practice Address - State:IA
Practice Address - Zip Code:52772-1347
Practice Address - Country:US
Practice Address - Phone:563-886-2133
Practice Address - Fax:563-886-1555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-31
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA313M00000X
IA160886314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0805820Medicaid
IA0805820Medicaid