Healthcare Provider Details

I. General information

NPI: 1275464174
Provider Name (Legal Business Name): 4210 HICKMAN RD OPCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4210 HICKMAN RD
DES MOINES IA
50310-3333
US

IV. Provider business mailing address

4210 HICKMAN RD
DES MOINES IA
50310-3333
US

V. Phone/Fax

Practice location:
  • Phone: 515-271-6141
  • 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

VIII. Authorized Official

Name: JONAH SVARC
Title or Position: MEMBER
Credential:
Phone: 917-474-4967