Healthcare Provider Details

I. General information

NPI: 1114963154
Provider Name (Legal Business Name): 21ST CENTURY REHAB, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1003 8TH ST SW STE D
ALTOONA IA
50009-2350
US

IV. Provider business mailing address

PO BOX 461
NEVADA IA
50201-0461
US

V. Phone/Fax

Practice location:
  • Phone: 515-967-4124
  • Fax: 515-967-9094
Mailing address:
  • Phone: 515-382-3366
  • Fax: 515-382-1576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE R CASSABAUM
Title or Position: CFO
Credential:
Phone: 515-382-3366