Provider Demographics
NPI:1689671158
Name:SUNSET KNOLL, INC.
Entity Type:Organization
Organization Name:SUNSET KNOLL, INC.
Other - Org Name:SUNSET KNOLL CARE AND REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:R
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-434-2294
Mailing Address - Street 1:401 WEST 5TH STREET
Mailing Address - Street 2:
Mailing Address - City:AURELIA
Mailing Address - State:IA
Mailing Address - Zip Code:51005-0067
Mailing Address - Country:US
Mailing Address - Phone:712-434-2294
Mailing Address - Fax:712-434-2153
Practice Address - Street 1:401 WEST 5TH STREET
Practice Address - Street 2:
Practice Address - City:AURELIA
Practice Address - State:IA
Practice Address - Zip Code:51005-0067
Practice Address - Country:US
Practice Address - Phone:712-434-2294
Practice Address - Fax:712-434-2153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-30
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA165535314000000X
IA180325314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0803940Medicaid
IA165535Medicare Oscar/Certification
IA0803940Medicaid