BLACK HAWK NURSING AND REHABILITATION, LLC (NPI# 1285106567) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1285106567 |
| Entity Type | Organization |
| Organization Name | BLACK HAWK NURSING AND REHABILITATION, LLC |
| Practice Address |
1410 W Dunkerton Rd Waterloo IA 50703-9648 |
| Mailing Address |
8170 Mccormick Blvd Ste 124 Skokie IL 60076-2961 |
| Practice Telephone | 3192912509 |
| Mailing Telephone | 3123305754 |
| Enumeration Date | 2018-12-26 |
| Last Update Date | 2018-12-26 |
| Authorized Official Name | MR. ILYA SHULMAN (CFO) |
| Authorized Official Telephone | 2244706512 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 314000000X | Skilled Nursing Facility | Nursing & Custodial Care Facilities |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538631817 | Black Hawk Nursing and Rehabilitation, LLC | Intermediate Care Facility, Mental Illness | 1410 W Dunkerton Rd, Waterloo, IA 50703-9648 | 2018-12-26 |
| 1891267175 | Black Hawk Nursing and Rehabilitation, LLC | Intermediate Care Facility, Mentally Retarded | 1410 W Dunkerton Rd, Waterloo, IA 50703-9648 | 2018-12-26 |
| Street Address |
1410 W DUNKERTON RD |
| City | WATERLOO |
| State | IA |
| Zip Code | 50703-9648 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346245347 | County of Blackhawk | Nursing Facility/Intermediate Care Facility | 1410 W Dunkerton Rd, Waterloo, IA 50703-9648 | 2005-06-16 |
| 1275141350 | Elevate Ccbhc LLC | Clinic/Center | 1410 W Dunkerton Rd, Waterloo, IA 50703-9648 | 2020-07-15 |
| 1710503982 | Elevate Housing Foundation | Clinic/Center | 1410 W Dunkerton Rd, Waterloo, IA 50703-9648 | 2020-06-23 |
| 1538631817 | Black Hawk Nursing and Rehabilitation, LLC | Intermediate Care Facility, Mental Illness | 1410 W Dunkerton Rd, Waterloo, IA 50703-9648 | 2018-12-26 |
| 1891267175 | Black Hawk Nursing and Rehabilitation, LLC | Intermediate Care Facility, Mentally Retarded | 1410 W Dunkerton Rd, Waterloo, IA 50703-9648 | 2018-12-26 |
| 1033496518 | Country View | Intermediate Care Facility, Mental Illness | 1410 W Dunkerton Rd, Waterloo, IA 50703-9648 | 2011-11-10 |
| 1811067143 | Country View | Intermediate Care Facility, Mentally Retarded | 1410 W Dunkerton Rd, Waterloo, IA 50703-9648 | 2006-11-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306363841 | Kristie Wood | Counselor | 1420 W. Donald St, Waterloo, IA 50703 | 2017-08-25 |
| 1215359054 | Chuck Corwin | Counselor | 607 Sycamore Street, Suite 300, Waterloo, IA 50703 | 2014-01-14 |
| 1679672554 | Linda D Bartollas | Social Worker | 146 West Dale Street, Suite 101, Waterloo, IA 50703 | 2006-09-21 |
| 1558477745 | Brent Matthew Hintz | Obstetrics & Gynecology | 212 West Dale St., Suite 402, Waterloo, IA 50703 | 2006-08-21 |
| 1588629729 | Mir Ahmad Waziri | Pediatrics | 212 W Dale Street, Suite 302, Waterloo, IA 50703 | 2006-04-19 |
| 1568432615 | Wei Yang | Pathology | Northeast Iowa Pathology Associates, PC, 1825 Logan Avenue, Waterloo, IA 50703 | 2006-01-23 |
| 1689158040 | Megan Elizabeth O'neal | Nurse Practitioner | 1631 Logan Ave, Waterloo, IA 50703 | 2018-09-21 |
| 1972031359 | Stephanie Rose Smith | Nurse Practitioner | 1631 Logan Ave, Waterloo, IA 50703 | 2017-05-30 |
| 1801263462 | Krissy Jean Wieland | Nurse Practitioner | 220 Franklin St, Waterloo, IA 50703 | 2015-08-28 |
| 1699169698 | Jens Masters Olsen | Emergency Medicine | 1825 Logan Ave, Waterloo, IA 50703 | 2015-03-27 |
| Find all providers in zip 50703 | ||||
| Taxonomy Code | 314000000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Skilled Nursing Facility |
| (1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis. |
| Notes: Source: (1) "Glossary of terms used in managed care" Developed by the Managed Care Assembly (MCA) of Medical Group Management Association (MGMA), MGM Journal, September/October 1995, p. 64; (2) AHA Guide, 1996 Annual Survey. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548780828 | Monroe County | Skilled Nursing Facility | 623 Hamacher St, Waterloo, IL 62298-1786 | 2017-06-27 |
| 1003854944 | Manor Care of Waterloo Ia LLC | Skilled Nursing Facility | 201 W Ridgeway Ave, Waterloo, IA 50701-4235 | 2006-06-03 |
| 1780657247 | Care Initiatives | Skilled Nursing Facility | 2651 Saint Francis Dr, Waterloo, IA 50702-5442 | 2006-02-07 |
| 1063484780 | Care Initiatives | Skilled Nursing Facility | 2001 Heath Street, Waterloo, IA 50703-1214 | 2006-02-06 |
| 1174525505 | Abcm Corporation | Skilled Nursing Facility | 2950 W Shaulis Rd, Waterloo, IA 50701-9702 | 2005-08-15 |
| 1194724906 | Canterbury Manor Nursing Center Inc | Skilled Nursing Facility | 718 N Market St, Waterloo, IL 62298-1014 | 2005-07-14 |
| 1942205182 | Seneca Nursing and Rehabilitation | Skilled Nursing Facility | 200 Douglas Dr, Waterloo, NY 13165-1645 | 2005-06-15 |
| 1164424487 | Monroe County | Skilled Nursing Facility | 623 Hamacher Street, Waterloo, IL 62298-1598 | 2005-06-01 |
| 1003289372 | Orthopaedic and Neurological Rehabilitation,inc | Skilled Nursing Facility | 2651 Saint Francis Dr, Waterloo, IA 50702-5442 | 2015-11-08 |
| 1639348873 | Friendship Village Inc. | Skilled Nursing Facility | 600 Park Ln, Waterloo, IA 50702-5200 | 2008-02-21 |
| Find all providers in WATERLOO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.