MEDICARE: STONEBRIDGE SUITES OF ROCK RAPIDS, 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	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1558182311
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STONEBRIDGE SUITES OF ROCK RAPIDS, LLC

Provider Business Mailing Address
First Line	:	4344 CORPORATE DR
Second Line	:
City	:	WEST DES MOINES
State	:	IA
Zip	:	50266-5907
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1510 S CARROLL ST
Second Line	:
City	:	ROCK RAPIDS
State	:	IA
Zip	:	51246-2078
Country	:	US
Telephone Number	:	712-472-4100
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	TED LENEAVE
Credential	:
Telephone Number	:	515-444-8056

Provider Enumeration Date	:	10/23/2024
Last Update Date	:	10/23/2024

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