Provider Demographics
NPI:1699768630
Name:COMMUNITY CARE CENTER INC
Entity type:Organization
Organization Name:COMMUNITY CARE CENTER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARADITH
Authorized Official - Middle Name:ANETTE
Authorized Official - Last Name:JANSSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-523-2815
Mailing Address - Street 1:325 SW 7TH ST
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:IA
Mailing Address - Zip Code:50250-2098
Mailing Address - Country:US
Mailing Address - Phone:515-523-2815
Mailing Address - Fax:515-523-9123
Practice Address - Street 1:325 SW 7TH ST
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:IA
Practice Address - Zip Code:50250-2098
Practice Address - Country:US
Practice Address - Phone:515-523-2815
Practice Address - Fax:515-523-9123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-24
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0800813Medicaid
IA0147108OtherELDERLY WAIVER
IA0147108OtherELDERLY WAIVER