Healthcare Provider Details

I. General information

NPI: 1285106567
Provider Name (Legal Business Name): BLACK HAWK NURSING AND REHABILITATION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2018
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1410 W DUNKERTON RD
WATERLOO IA
50703-9648
US

IV. Provider business mailing address

7366 N LINCOLN AVE STE 301
LINCOLNWOOD IL
60712-1740
US

V. Phone/Fax

Practice location:
  • Phone: 319-291-2509
  • Fax:
Mailing address:
  • Phone: 847-494-0089
  • 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: AMIRA KRVAVAC
Title or Position: AR DIRECTOR
Credential:
Phone: 224-470-2657