Healthcare Provider Details

I. General information

NPI: 1992793475
Provider Name (Legal Business Name): SHELL ROCK HEALTHCARE CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 10/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 N CHERRY ST
SHELL ROCK IA
50670-9760
US

IV. Provider business mailing address

920 N CHERRY ST
SHELL ROCK IA
50670-9760
US

V. Phone/Fax

Practice location:
  • Phone: 319-885-4341
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberN086
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberN-086
License Number StateIA

VIII. Authorized Official

Name: HOWIE GROFF
Title or Position: PRESIDENT
Credential:
Phone: 952-888-2923