Provider Demographics
NPI:1427055037
Name:MASON CITY HEALTHCARE
Entity type:Organization
Organization Name:MASON CITY HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-423-3355
Mailing Address - Street 1:222 S PIERCE AVE
Mailing Address - Street 2:
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50401-2748
Mailing Address - Country:US
Mailing Address - Phone:641-423-3355
Mailing Address - Fax:641-423-7006
Practice Address - Street 1:222 S PIERCE AVE
Practice Address - Street 2:
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401-2748
Practice Address - Country:US
Practice Address - Phone:641-423-3355
Practice Address - Fax:641-423-7006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA170364314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0805200Medicaid
IA65139OtherBCBS PROV#
IA0805200Medicaid