BLACK HAWK NURSING AND REHABILITATION, LLC
Complete NPI Record 1285106567
Skilled Nursing Facility in Waterloo, IA
Active since December 26, 2018
3/5
Overall Rating
Complete NPI Dataset
This page contains the complete raw NPPES record for Black Hawk Nursing And Rehabilitation, Llc (NPI 1285106567), a skilled nursing facility organization in Waterloo, IA. All 26 fields on file are listed with their current values and official NPPES definitions, exactly as recorded in the National Plan and Provider Enumeration System. Only fields that contain data are included, so the number of fields shown varies from one NPI record to another.
Use the tools below to filter fields by category, search within the record, or jump straight to a specific field. You can download the full record as a CSV, JSON, Markdown or text file, or filter first and export only the fields you need. The Print Clean Summary button produces a printer-friendly copy of the record.
Registry File Document Utilities
- NPI: 1285106567 Field 1/26
- The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
- Entity Type Code: 2 Field 2/26
- Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
- Employer Identification Number EIN: Not available Field 3/26
- The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
- Provider Organization Name Legal Business Name: BLACK HAWK NURSING AND REHABILITATION, LLC Field 4/26
- The name of the organization provider. If the provider is an organization, this is the legal business name.
- Provider First Line Business Mailing Address: 7366 N LINCOLN AVE STE 301 Field 5/26
- The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
- Provider Business Mailing Address City Name: LINCOLNWOOD Field 6/26
- The city name in the mailing address of the provider being identified.
- Provider Business Mailing Address State Name: IL Field 7/26
- The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".
- Provider Business Mailing Address Postal Code: 607121740 Field 8/26
- The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
- Provider Business Mailing Address Country Code If outside U S : US Field 9/26
- The country code in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address country code".
- Provider Business Mailing Address Telephone Number: 8474940089 Field 10/26
- The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as "Provider location address telephone number".
- Provider First Line Business Practice Location Address: 1410 W DUNKERTON RD Field 11/26
- The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
- Provider Business Practice Location Address City Name: WATERLOO Field 12/26
- The city name in the location address of the provider being identified.
- Provider Business Practice Location Address State Name: IA Field 13/26
- The State code in the location of the provider being identified.
- Provider Business Practice Location Address Postal Code: 507039648 Field 14/26
- The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
- Provider Business Practice Location Address Country Code If outside U S : US Field 15/26
- The country code in the location address of the provider being identified.
- Provider Business Practice Location Address Telephone Number: 3192912509 Field 16/26
- The telephone number associated with the location address of the provider being identified.
- Authorized Official Last Name: KRVAVAC Field 19/26
- The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
- Authorized Official First Name: AMIRA Field 20/26
- The first name of the authorized official.
- Authorized Official Title or Position: AR DIRECTOR Field 21/26
- The title or position of the authorized official.
- Authorized Official Telephone Number: 2244702657 Field 22/26
- The 10-position telephone number of the authorized official.
- Healthcare Provider Taxonomy Code 1: 314000000X Field 23/26
- This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
- Healthcare Provider Primary Taxonomy Switch 1: Y Field 24/26
- This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
- Is Organization Subpart: N Field 25/26
- Indicates whether the provider is a subpart of a larger organization. This is a single-character code: "Y" means the entity is an organizational subpart, while "N" means it is not. Subparts typically include hospital departments, clinics, or other distinct units that fall under a parent organization.
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