MEDICARE: BLACK HAWK NURSING AND REHABILITATION, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310500000X	Mental Illness Intermediate Care Facility

General Provider Information

NPI Number	:	1538631817
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLACK HAWK NURSING AND REHABILITATION, LLC

Provider Business Mailing Address
First Line	:	7366 N LINCOLN AVE STE 301
Second Line	:
City	:	LINCOLNWOOD
State	:	IL
Zip	:	60712-1740
Country	:	US
Telephone Number	:	847-494-0089
Fax Number	:

Provider Business Practice Location Address
First Line	:	1410 W DUNKERTON RD
Second Line	:
City	:	WATERLOO
State	:	IA
Zip	:	50703-9648
Country	:	US
Telephone Number	:	319-291-2509
Fax Number	:

Authorized Official
Title or Position	:	AR DIRECTOR
Name	:	AMIRA KRVAVAC
Credential	:
Telephone Number	:	224-470-2657

Provider Enumeration Date	:	12/26/2018
Last Update Date	:	09/11/2025

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