Provider Demographics
NPI:1588113815
Name:DONNELLSON HEALTHCARE AND REHABILITATION CENTER LLC
Entity type:Organization
Organization Name:DONNELLSON HEALTHCARE AND REHABILITATION CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MOSHE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRODT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-379-8074
Mailing Address - Street 1:1576 E 27TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-1710
Mailing Address - Country:US
Mailing Address - Phone:917-379-8074
Mailing Address - Fax:
Practice Address - Street 1:901 STATE ST
Practice Address - Street 2:
Practice Address - City:DONNELLSON
Practice Address - State:IA
Practice Address - Zip Code:52625-9425
Practice Address - Country:US
Practice Address - Phone:319-835-5621
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-28
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
165260Medicare Oscar/Certification