Healthcare Provider Details

I. General information

NPI: 1881139749
Provider Name (Legal Business Name): PEARL VALLEY REHABILITATION AND NURSING AT ESTHERVILLE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2017
Last Update Date: 01/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 1ST AVE N
ESTHERVILLE IA
51334-2788
US

IV. Provider business mailing address

1576 E 27TH ST
BROOKLYN NY
11229-1710
US

V. Phone/Fax

Practice location:
  • Phone: 712-362-3594
  • Fax: 712-362-8013
Mailing address:
  • Phone: 712-362-3594
  • Fax: 712-362-8013

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: YAAKOV DORFMAN
Title or Position: OWNER (GREATER THAN 5 PERCENT)
Credential:
Phone: 551-206-2647