Provider Demographics
NPI:1194269225
Name:MEADOWBROOK CARE AND REHABILITATION CENTER LLC
Entity type:Organization
Organization Name:MEADOWBROOK CARE AND REHABILITATION CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHWARTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-635-1195
Mailing Address - Street 1:2500 ARROWHEAD DR
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-4225
Mailing Address - Country:US
Mailing Address - Phone:605-348-0285
Mailing Address - Fax:605-343-5771
Practice Address - Street 1:2500 ARROWHEAD DR
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-4225
Practice Address - Country:US
Practice Address - Phone:605-348-0285
Practice Address - Fax:605-343-5771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-08
Last Update Date:2017-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA435051OtherPTAN
435051Medicare Oscar/Certification