Healthcare Provider Details

I. General information

NPI: 1134149529
Provider Name (Legal Business Name): RISEN SON CHRISTIAN VILLAGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 RISEN SON BLVD
COUNCIL BLUFFS IA
51503-1911
US

IV. Provider business mailing address

3000 RISEN SON BLVD
COUNCIL BLUFFS IA
51503-1911
US

V. Phone/Fax

Practice location:
  • Phone: 712-366-9655
  • Fax: 712-366-4748
Mailing address:
  • Phone: 712-366-9655
  • Fax: 712-366-4748

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number780641
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number780641
License Number StateIA
# 3
Primary TaxonomyY
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number780641
License Number StateIA

VIII. Authorized Official

Name: MRS. SUSAN MCGHEE
Title or Position: CONTROLLER
Credential:
Phone: 217-732-5175