Provider Demographics
NPI:1316913205
Name:TIMELY MISSION NURSING HOME
Entity type:Organization
Organization Name:TIMELY MISSION NURSING HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:B
Authorized Official - Last Name:WEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-562-2844
Mailing Address - Street 1:109 MISSION DR
Mailing Address - Street 2:
Mailing Address - City:BUFFALO CENTER
Mailing Address - State:IA
Mailing Address - Zip Code:50424-1034
Mailing Address - Country:US
Mailing Address - Phone:641-562-2844
Mailing Address - Fax:641-562-2499
Practice Address - Street 1:109 MISSION DR
Practice Address - Street 2:
Practice Address - City:BUFFALO CENTER
Practice Address - State:IA
Practice Address - Zip Code:50424-1034
Practice Address - Country:US
Practice Address - Phone:641-562-2844
Practice Address - Fax:641-562-2499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-28
Last Update Date:2013-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA950348313M00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA165586Medicare Oscar/Certification