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NPI Code Detail

MEDICARE: INDEPENDENCE IA SKILLED NURSING FACILITY, LLC

MEDICARE: INDEPENDENCE IA SKILLED NURSING FACILITY, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1314000000XSkilled Nursing Facility

General Provider Information

NPI Number : 1477328169
Entity Type Code : Organization
Provider Name (Legal Business Name) : INDEPENDENCE IA SKILLED NURSING FACILITY, LLC
Provider Business Mailing Address
First Line : 1610 3RD ST NE
Second Line :
City : INDEPENDENCE
State : IA
Zip : 50644-2228
Country : US
Telephone Number : 319-334-6039
Fax Number :
Provider Business Practice Location Address
First Line : 1610 3RD ST NE
Second Line :
City : INDEPENDENCE
State : IA
Zip : 50644-2228
Country : US
Telephone Number : 319-334-6039
Fax Number :
Authorized Official
Title or Position : PRINCIPAL
Name : CHAIM RAJCHENBACH
Credential :
Telephone Number : 847-745-7000
Provider Enumeration Date : 11/22/2023
Last Update Date : 11/22/2023

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