Healthcare Provider Details

I. General information

NPI: 1093580821
Provider Name (Legal Business Name): BLOOMFIELD IA SKILLED NURSING FACILITY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2023
Last Update Date: 07/22/2024
Certification Date: 07/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 N DAVIS ST
BLOOMFIELD IA
52537-1107
US

IV. Provider business mailing address

800 N DAVIS ST
BLOOMFIELD IA
52537-1107
US

V. Phone/Fax

Practice location:
  • Phone: 641-664-2699
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: CHAIM RAJCHENBACH
Title or Position: PRINCIPAL
Credential:
Phone: 847-745-7000