Provider Demographics
NPI:1295728319
Name:ROCKWELL COMMUNITY NURSING HOME, INC
Entity type:Organization
Organization Name:ROCKWELL COMMUNITY NURSING HOME, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-822-3203
Mailing Address - Street 1:707 ELM ST E
Mailing Address - Street 2:
Mailing Address - City:ROCKWELL
Mailing Address - State:IA
Mailing Address - Zip Code:50469-1035
Mailing Address - Country:US
Mailing Address - Phone:641-822-3203
Mailing Address - Fax:641-822-3201
Practice Address - Street 1:707 ELM ST E
Practice Address - Street 2:
Practice Address - City:ROCKWELL
Practice Address - State:IA
Practice Address - Zip Code:50469-1035
Practice Address - Country:US
Practice Address - Phone:641-822-3203
Practice Address - Fax:641-822-3201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-24
Last Update Date:2009-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA165406314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0803486Medicaid
IA0803486Medicaid