Provider Demographics
NPI:1174595698
Name:EXIRA CARE CENTER CORPORATION
Entity type:Organization
Organization Name:EXIRA CARE CENTER CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:FISTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-268-5393
Mailing Address - Street 1:411 S CARTHAGE ST
Mailing Address - Street 2:
Mailing Address - City:EXIRA
Mailing Address - State:IA
Mailing Address - Zip Code:50076-1502
Mailing Address - Country:US
Mailing Address - Phone:712-268-5393
Mailing Address - Fax:712-268-9742
Practice Address - Street 1:409 S CARTHAGE ST
Practice Address - Street 2:
Practice Address - City:EXIRA
Practice Address - State:IA
Practice Address - Zip Code:50076-1502
Practice Address - Country:US
Practice Address - Phone:712-268-5393
Practice Address - Fax:712-268-9742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-07
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAN-0106314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1174595698Medicaid
IA165412Medicare Oscar/Certification