Active NPI
County of Dubuque
Doing business as Sunnycrest Manor
- Nursing Facility/Intermediate Care Facility
- Dubuque, IA
National Provider Identifier
1215934955
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nursing Facility/Intermediate Care Facility
- License
- 310304
- Legal business name
- COUNTY OF DUBUQUE
- Doing business as
- Sunnycrest Manor
- Practice address
- 2375 Roosevelt St
Dubuque, IA 52001-1479 - Phone
- (563) 583-1781
- Fax
- (563) 583-1705
- NPI assigned
- Jul 7, 2005
- Last updated
- Nov 1, 2011
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Ms. Cathryn M. Hedley, NURSING HOME ADMINIS
- Title
- Administrator
- Phone
- (563) 583-1781
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Custodial Care Facility | 311Z00000X | 310304 | IA | |
| Nursing Facility/Intermediate Care Facility | 313M00000X | 310304 | IA | Primary |
| Skilled Nursing Facility | 314000000X | 310304 | IA | |
| Intellectual Disabilities Intermediate Care Facility | 315P00000X | IMR-304 | IA |
Addresses
Primary practice location
2375 Roosevelt St
Dubuque, IA 52001-1479
Mailing address
2375 Roosevelt St
Dubuque, IA 52001-1479
Phone (563) 583-1781
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0803866 | Medicaid | IA |
Other names 1
- Sunnycrest Manor
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040625000864 | IA | Part A Provider - Skilled Nursing Facility | 0840276382 | Practice locations: Dubuque, IA |
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1215934955. Details of each certification follow.
Skilled nursing facility certification: CCN 165556
- Legal name
- COUNTY OF DUBUQUE
- Doing business as
- SUNNYCREST MANOR
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- May 1, 2005
- Last certification
- Feb 27, 2025
- Beds
- 77
- Ownership / control type
- County
- Organization structure
- Government
- Enrollment address
- 2375 Roosevelt St
Dubuque, IA 52001-1479 - Nursing home name
- SUNNYCREST MANOR
Care Compare: Nursing home
Medicare Care Compare- Listed as
- Sunnycrest Manor
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- Government - County
- Certified
- May 1, 2005
- Medicare certification status
- Active
- Certified beds
- 77
National Provider Directory
National Provider DirectoryOwnership & related parties
All disclosed owners & managing parties 2
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| County of Dubuque | Operational/Managerial Control | Apr 28, 2021 | |
| Danielle Ettema | W-2 Managing Employee | Apr 28, 2021 | 50% |
| Operational/Managerial Control | Apr 28, 2021 | 10% |
Practitioners & affiliated clinicians
Affiliated clinicians 9
Clinicians who list this facility as an affiliation in Medicare Care Compare.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1120694400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1320105600000",
"number": "1215934955",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2375 ROOSEVELT ST",
"city": "DUBUQUE",
"state": "IA",
"postal_code": "520011479",
"telephone_number": "563-583-1781",
"fax_number": "563-583-1705"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2375 ROOSEVELT ST",
"city": "DUBUQUE",
"state": "IA",
"postal_code": "520011479",
"telephone_number": "563-583-1781",
"fax_number": "563-583-1705"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "COUNTY OF DUBUQUE",
"organizational_subpart": "NO",
"enumeration_date": "2005-07-07",
"last_updated": "2011-11-01",
"status": "A",
"authorized_official_last_name": "HEDLEY",
"authorized_official_first_name": "CATHRYN",
"authorized_official_middle_name": "M.",
"authorized_official_title_or_position": "ADMINISTRATOR",
"authorized_official_telephone_number": "563-583-1781",
"authorized_official_name_prefix": "Ms.",
"authorized_official_credential": "NURSING HOME ADMINIS"
},
"taxonomies": [
{
"code": "311Z00000X",
"taxonomy_group": "",
"desc": "Custodial Care Facility",
"state": "IA",
"license": "310304",
"primary": false
},
{
"code": "313M00000X",
"taxonomy_group": "",
"desc": "Nursing Facility/Intermediate Care Facility",
"state": "IA",
"license": "310304",
"primary": true
},
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": "IA",
"license": "310304",
"primary": false
},
{
"code": "315P00000X",
"taxonomy_group": "",
"desc": "Intermediate Care Facility, Intellectual Disabilities",
"state": "IA",
"license": "IMR-304",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0803866",
"state": "IA"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Sunnycrest Manor",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Dubuque, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.