Healthcare Provider Details

I. General information

NPI: 1205374030
Provider Name (Legal Business Name): PEARL VALLEY REHABILITATION AND NURSING AT PERRY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2017
Last Update Date: 01/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2625 IOWA ST
PERRY IA
50220-2413
US

IV. Provider business mailing address

1576 E 27TH ST
BROOKLYN NY
11229-1710
US

V. Phone/Fax

Practice location:
  • Phone: 515-465-5349
  • Fax: 515-465-9880
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: MOSHE BRODT
Title or Position: OWNER MORE THAN 5 PERCENT INTEREST
Credential:
Phone: 917-379-8074