BLACK HAWK NURSING AND REHABILITATION, LLC (NPI# 1538631817) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1538631817 |
| 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 Skokie IL 60076-2961 |
| Practice Telephone | 3192912509 |
| Mailing Telephone | 3123305754 |
| Enumeration Date | 2018-12-26 |
| Last Update Date | 2018-12-26 |
| Authorized Official Name | ILYA SHULMAN (CFO) |
| Authorized Official Telephone | 2244706512 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 310500000X | Intermediate Care Facility, Mental Illness | Nursing & Custodial Care Facilities |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285106567 | Black Hawk Nursing and Rehabilitation, LLC | Skilled Nursing Facility | 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 |
| 1285106567 | Black Hawk Nursing and Rehabilitation, LLC | Skilled Nursing Facility | 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 | 310500000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Intermediate Care Facility, Mental Illness |
| A nursing facility that provides an intermediate level of nursing care to individuals whose functional abilities are significantly compromise by mental illness. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033496518 | Country View | Intermediate Care Facility, Mental Illness | 1410 W Dunkerton Rd, Waterloo, IA 50703-9648 | 2011-11-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366740268 | Daves Place | Intermediate Care Facility, Mental Illness | 3140 Plank Rd, Keokuk, IA 52632-2312 | 2011-03-02 |
| 1124162532 | Childserve Homes Inc. | Intermediate Care Facility, Mental Illness | 5406 Merle Hay Rd, Johnston, IA 50131-1209 | 2007-02-18 |
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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.