Prime Nursing and Rehabilitation Center, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

770236 Issued in IA

Legal business name

PRIME NURSING AND REHABILITATION CENTER, LLC

Practice address

600 E 5TH St
Des Moines, IA 50309-5418

Phone

(515) 243-6195

Fax

(515) 243-6913

NPI assigned

Jun 26, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. John R Grosenheider

Title

Managing Member

Phone

(712) 540-3332

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Prime Nursing & Rehabilitation Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1182816000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1385424000000",
    "number": "1124224969",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 E 5TH ST",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503095418",
            "telephone_number": "515-243-6195",
            "fax_number": "515-243-6913"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 E 5TH ST",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503095418",
            "telephone_number": "515-243-6195",
            "fax_number": "515-243-6913"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIME NURSING AND REHABILITATION CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-26",
        "last_updated": "2013-11-26",
        "status": "A",
        "authorized_official_last_name": "GROSENHEIDER",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "712-540-3332",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "IA",
            "license": "770236",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0800013",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Prime Nursing & Rehabilitation",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.