Provider Demographics
NPI:1932646767
Name:PEARL VALLEY REHABILITATION AND NURSING AT PRIMGHAR, LLC
Entity Type:Organization
Organization Name:PEARL VALLEY REHABILITATION AND NURSING AT PRIMGHAR, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER MORE THAN 5 PERCENT INTEREST
Authorized Official - Prefix:
Authorized Official - First Name:MOSHE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRODT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-379-8074
Mailing Address - Street 1:1576 E 27TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-1710
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:735 N RERICK AVE
Practice Address - Street 2:
Practice Address - City:PRIMGHAR
Practice Address - State:IA
Practice Address - Zip Code:51245-1052
Practice Address - Country:US
Practice Address - Phone:712-957-3655
Practice Address - Fax:712-957-8501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-31
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility