Provider Demographics
NPI:1649411166
Name:THE REHABILITATION CENTER OF DES MOINES, LLC
Entity Type:Organization
Organization Name:THE REHABILITATION CENTER OF DES MOINES, LLC
Other - Org Name:THE REHABILITATION CENTER OF DES MOINES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:T
Authorized Official - Last Name:BERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-468-4752
Mailing Address - Street 1:701 RIVERVIEW ST
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50316-2343
Mailing Address - Country:US
Mailing Address - Phone:515-266-1106
Mailing Address - Fax:515-266-5906
Practice Address - Street 1:701 RIVERVIEW ST
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50316-2343
Practice Address - Country:US
Practice Address - Phone:515-266-1106
Practice Address - Fax:515-266-5906
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUMMIT CARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-03-12
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA770202314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1649411166Medicaid
IA165268Medicare Oscar/Certification