Provider Demographics
NPI:1114963154
Name:21ST CENTURY REHAB PC
Entity Type:Organization
Organization Name:21ST CENTURY REHAB PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:R
Authorized Official - Last Name:CASSABAUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-382-3366
Mailing Address - Street 1:PO BOX 461
Mailing Address - Street 2:
Mailing Address - City:NEVADA
Mailing Address - State:IA
Mailing Address - Zip Code:50201-0461
Mailing Address - Country:US
Mailing Address - Phone:515-382-3366
Mailing Address - Fax:515-382-1576
Practice Address - Street 1:612 8TH ST SW
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:IA
Practice Address - Zip Code:50009-4124
Practice Address - Country:US
Practice Address - Phone:515-967-4124
Practice Address - Fax:515-967-9094
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:21ST CENTURY REHAB PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-20
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
139763501OtherOWCP FED WC ALTOONA
66554OtherBCBS ALTOONA
F1001OtherMIDLANDS
3432608OtherPREMIER PROV NETWK
IA0665547Medicaid
154075OtherIOWA HEALTH SOLUTIONS
66554OtherBCBS ALTOONA