Provider Demographics
NPI:1124141999
Name:MANNING REGIONAL HEALTHCARE CENTER
Entity type:Organization
Organization Name:MANNING REGIONAL HEALTHCARE CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:OBRIEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:1712-655-2072
Mailing Address - Street 1:402 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MANNING
Mailing Address - State:IA
Mailing Address - Zip Code:51455-1033
Mailing Address - Country:US
Mailing Address - Phone:712-655-2072
Mailing Address - Fax:712-655-3330
Practice Address - Street 1:402 MAIN ST
Practice Address - Street 2:
Practice Address - City:MANNING
Practice Address - State:IA
Practice Address - Zip Code:51455-1033
Practice Address - Country:US
Practice Address - Phone:712-655-2072
Practice Address - Fax:712-655-3330
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MANNING REGIONAL HEALTHCARE CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-09
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA140058H313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0802421Medicaid
IA6-E069OtherBLUE CROSS NF PROVIDER #
IA16E069Medicaid