NPIMap

Organization Active NPI

Jefferson County Hospital

Doing business as JCH Living Care Center

  • Nursing Facility/Intermediate Care Facility
  • Fairfield, IA
National Provider Identifier
1871690289
Registry record updated Dec 30, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nursing Facility/Intermediate Care FacilityTaxonomy code 313M00000X
License
510063H Issued in IA
Legal business name
JEFFERSON COUNTY HOSPITAL
Doing business as
JCH Living Care Center
Practice address
400 Highland St
Fairfield, IA 52556-3713
Phone
(641) 472-4111
Fax
(641) 469-4375
NPI assigned
Sep 20, 2006
Last updated
Dec 30, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 30, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Deborah K Cardin
Title
Chief Executive Officer
Phone
(641) 472-4111

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nursing Facility/Intermediate Care Facility 313M00000X 510063H IA Primary

Addresses

Primary practice location

400 Highland St
Fairfield, IA 52556-3713

Mailing address

400 Highland St
Fairfield, IA 52556-3713
Phone (641) 472-4111

Other identifiers 1

IdentifierTypeStateIssuer
0809681MedicaidIA

Other names 1

  • JCH LIVING CARE CENTER Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1871690289. Details of each certification follow.

Hospital certification: CCN 160115

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
JEFFERSON COUNTY HOSPITAL
Certification status
Terminated Other: provider status change, Oct 31, 2004
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Aug 15, 2002
Beds
67 (51 certified)
Ownership / control type
Local
Facility address
400 Highland
Fairfield, IA 52556

National Provider Directory

National Provider Directory
Tax ID family
Jefferson Co Hosp11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1230595200000",
    "number": "1871690289",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 HIGHLAND ST",
            "city": "FAIRFIELD",
            "state": "IA",
            "postal_code": "525563713",
            "telephone_number": "641-472-4111",
            "fax_number": "641-469-4375"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 HIGHLAND ST",
            "city": "FAIRFIELD",
            "state": "IA",
            "postal_code": "525563713",
            "telephone_number": "641-472-4111",
            "fax_number": "641-469-4375"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFFERSON COUNTY HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-20",
        "last_updated": "2008-12-30",
        "status": "A",
        "authorized_official_last_name": "CARDIN",
        "authorized_official_first_name": "DEBORAH",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "641-472-4111",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "IA",
            "license": "510063H",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0809681",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "JCH LIVING CARE CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fairfield, IA

Sources for this page

Verify at the official NPI Registry.