Provider Demographics
NPI:1346245347
Name:COUNTY OF BLACKHAWK
Entity Type:Organization
Organization Name:COUNTY OF BLACKHAWK
Other - Org Name:COUNTRY VIEW
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROVISIONAL ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:C
Authorized Official - Last Name:MEYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-291-2509
Mailing Address - Street 1:1410 W DUNKERTON RD
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50703-9648
Mailing Address - Country:US
Mailing Address - Phone:319-291-2509
Mailing Address - Fax:319-291-2570
Practice Address - Street 1:1410 W DUNKERTON RD
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50703-9648
Practice Address - Country:US
Practice Address - Phone:319-291-2509
Practice Address - Fax:319-291-2570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-16
Last Update Date:2013-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA070529313M00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0806984Medicaid
IA0181776Medicaid
IA165307Medicare Oscar/Certification
IA1176270001Medicare NSC