Healthcare Provider Details

I. General information

NPI: 1639945025
Provider Name (Legal Business Name): SHAULIS IA SKILLED NURSING FACILITY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2023
Last Update Date: 11/28/2023
Certification Date: 11/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2950 W SHAULIS RD
WATERLOO IA
50701-9702
US

IV. Provider business mailing address

2950 W SHAULIS RD
WATERLOO IA
50701-9702
US

V. Phone/Fax

Practice location:
  • Phone: 319-234-4495
  • 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: CHAIM RAJCHENBACH
Title or Position: PRINCIPAL
Credential:
Phone: 847-745-7000