BLACK HAWK NURSING AND REHABILITATION, LLC (NPI# 1891267175) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1891267175 |
| 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 | 315P00000X | Intermediate Care Facility, Mentally Retarded | 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 |
| 1538631817 | Black Hawk Nursing and Rehabilitation, LLC | Intermediate Care Facility, Mental Illness | 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 |
| 1538631817 | Black Hawk Nursing and Rehabilitation, LLC | Intermediate Care Facility, Mental Illness | 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 | 315P00000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Intermediate Care Facility, Mentally Retarded |
| (1) A public institution for care of the mentally retarded or people with related conditions. (2) An institution giving active treatment to mentally retarded or developmentally disabled persons or persons with related conditions. The primary purpose of the institution is to provide health or rehabilitative services to such individuals. |
| Notes: Sources: (1) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, IL: 1994, p. 403 (2) Paraphrased from Code of Federal Regulations #42, Public Health, Section 440.150(c). |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851563209 | Community Living Options Inc | Intermediate Care Facility, Mentally Retarded | 98 Debra Lane, Waterloo, IL 62298-1479 | 2008-03-26 |
| 1497819874 | Comprehensive Systems, Inc | Intermediate Care Facility, Mentally Retarded | 4049 Richland Dr, Waterloo, IA 50701-3118 | 2006-12-20 |
| 1477617264 | Comprehensive Systems, Inc | Intermediate Care Facility, Mentally Retarded | 2266 Country Ln, Waterloo, IA 50701-9736 | 2006-12-19 |
| 1396807038 | Comprehensive Systems, Inc. | Intermediate Care Facility, Mentally Retarded | 1100 S Hill Dr, Waterloo, IA 50701-5034 | 2006-12-15 |
| 1811067143 | Country View | Intermediate Care Facility, Mentally Retarded | 1410 W Dunkerton Rd, Waterloo, IA 50703-9648 | 2006-11-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912528266 | One Vision | Intermediate Care Facility, Mentally Retarded | 755 Pebblestone Lane, Garner, IA 50428 | 2020-04-28 |
| 1912544123 | Handicap Village | Intermediate Care Facility, Mentally Retarded | 1140 Limestone St, Mason City, IA 50401 | 2019-12-06 |
| 1003460312 | Rem Iowa, Inc. | Intermediate Care Facility, Mentally Retarded | 143 16th Ave Sw, Cedar Rapids, IA 52404 | 2019-07-25 |
| 1811541121 | Rem Iowa, Inc. | Intermediate Care Facility, Mentally Retarded | 2620 33rd Ave Sw, Cedar Rapids, IA 52404 | 2019-07-25 |
| 1952767162 | G & G Living Centers, Inc. | Intermediate Care Facility, Mentally Retarded | 602 Kosciusko St., Guttenberg, IA 52052-0967 | 2016-01-05 |
| 1487920351 | Mosaic | Intermediate Care Facility, Mentally Retarded | 835 S 7th St, Forest City, IA 50436-2127 | 2012-03-26 |
| 1306112271 | Mosaic | Intermediate Care Facility, Mentally Retarded | 102 Kellys Ct, Forest City, IA 50436-2245 | 2012-03-26 |
| 1710253687 | Mosaic | Intermediate Care Facility, Mentally Retarded | 105 Kellys Ct, Forest City, IA 50436-2245 | 2012-03-26 |
| 1831465715 | Mosaic | Intermediate Care Facility, Mentally Retarded | 315 Country Club Dr, Belmond, IA 50421-1740 | 2012-03-26 |
| 1851666820 | Mosaic | Intermediate Care Facility, Mentally Retarded | 718 S 13th St, Nevada, IA 50201-2435 | 2012-03-09 |
| Find all providers with the same taxonomy | ||||
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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.