Provider Demographics
NPI:1215934955
Name:COUNTY OF DUBUQUE
Entity type:Organization
Organization Name:COUNTY OF DUBUQUE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CATHRYN
Authorized Official - Middle Name:M
Authorized Official - Last Name:HEDLEY
Authorized Official - Suffix:
Authorized Official - Credentials:NURSING HOME ADMINIS
Authorized Official - Phone:563-583-1781
Mailing Address - Street 1:2375 ROOSEVELT ST
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001-1479
Mailing Address - Country:US
Mailing Address - Phone:563-583-1781
Mailing Address - Fax:563-583-1705
Practice Address - Street 1:2375 ROOSEVELT ST
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001-1479
Practice Address - Country:US
Practice Address - Phone:563-583-1781
Practice Address - Fax:563-583-1705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA310304311Z00000X, 313M00000X, 314000000X
IAIMR-304315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0803866Medicaid
IA165556Medicare Oscar/Certification