Provider Demographics
NPI:1205370798
Name:IPSWICH CARE AND REHABILITATION CENTER LLC
Entity Type:Organization
Organization Name:IPSWICH CARE AND REHABILITATION CENTER LLC
Other - Org Name:IPSWICH CARE AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHWARTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-635-1195
Mailing Address - Street 1:PO BOX 728
Mailing Address - Street 2:
Mailing Address - City:IPSWICH
Mailing Address - State:SD
Mailing Address - Zip Code:57451-0728
Mailing Address - Country:US
Mailing Address - Phone:605-426-6622
Mailing Address - Fax:605-426-6565
Practice Address - Street 1:617 BLOEMENDAAL DR
Practice Address - Street 2:
Practice Address - City:IPSWICH
Practice Address - State:SD
Practice Address - Zip Code:57451-0000
Practice Address - Country:US
Practice Address - Phone:605-426-6622
Practice Address - Fax:605-426-6565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-19
Last Update Date:2017-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA435055OtherPTAN
435055Medicare Oscar/Certification