Provider Demographics
NPI:1407016819
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 1:209 W 2ND ST
Practice Address - Street 2:
Practice Address - City:MADRID
Practice Address - State:IA
Practice Address - Zip Code:50156-1211
Practice Address - Country:US
Practice Address - Phone:515-795-2427
Practice Address - Fax:515-795-2482
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:21ST CENTURY REHAB, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-06-10
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA66559OtherWELLMARK BCBS
IA0665596Medicaid
IA0665596Medicaid