CCRC of Altoona LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

CCRC OF ALTOONA LLC

Practice address

2785 1St Ave S
Altoona, IA 50009-8820

Phone

(515) 967-8700

Fax

(515) 967-6032

NPI assigned

Oct 21, 2013

Organization subpart

No

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

Authorized official

Name

Scott E Gulledge

Title

Manager

Phone

(913) 890-4782

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Prairie Vista Village Doing business as

Medicare fee-for-service enrollment

Enrolled in IA

Enrollment records 1

Skilled nursing facility certification: CCN 165610

Legal name

CCRC OF ALTOONA LLC

Doing business as

PRAIRIE VISTA VILLAGE

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

Sep 6, 2014

Last certification

May 16, 2024

Beds

46

Ownership / control type

Limited Liability Corporation

Multi-facility organization

Pivotal Health Care

Organization structure

LLCProprietary

Enrollment address

2785 1St Ave S
Altoona, IA 50009-8823

Nursing home name

PRAIRIE VISTA VILLAGE

Affiliated entity

PIVOTAL HEALTH CARE

Listed as

Prairie Vista VillageCCN 165610

Overall star rating

5 of 5

Health inspections

4 of 5

Staffing

5 of 5

Quality measures

5 of 5

Type

Medicare and Medicaid

Ownership

For profit - Limited Liability company

Certified

Sep 6, 2014

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

4642.6 residents per day on average

Chain

Pivotal Health Care9 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

All disclosed owners & managing parties 24

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Owners & managing parties with NPI records 4

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

• Iowa Physicians Clinic Medical Foundation

  • General Practice Physician
  • West Des Moines, IA
  • NPI 1366425274

  Adp of the SNF

  CMS ownership
• Iowa Physicians Clinic Medical Foundation

  • Clinical Medical Laboratory
  • Cedar Falls, IA
  • NPI 1538617840

  Adp of the SNF

  CMS ownership
• Michael P O'Conner, DO

  • Internal Medicine Physician
  • Des Moines, IA
  • NPI 1396724167

  Adp of the SNF, Operational/Managerial Control

  CMS ownership
• Summit Care, LLC

  • Physical Therapist
  • Overland Park, KS
  • NPI 1033441027

  Adp of the SNF

  CMS ownership

Facilities with the same owner 9

Facilities that share an organizational owner with 5% or greater ownership or operational control.

• CCRC of Ames LLC

  • Skilled Nursing Facility
  • Ames, IA
  • NPI 1316322704

  Pivotal Health Care LLC, Scenic Development LLC

  CMS ownership
• CCRC of Grimes, LLC

  • Skilled Nursing Facility
  • Grimes, IA
  • NPI 1013200914

  Pivotal Health Care LLC, Scenic Development LLC

  CMS ownership
• CCRC of West Des Moines, LLC

  • Skilled Nursing Facility
  • West Des Moines, IA
  • NPI 1093286395

  Pivotal Health Care LLC, Scenic Development LLC

  CMS ownership
• CCRC of Cedar Rapids, LLC

  • Skilled Nursing Facility
  • Overland Park, KS
  • NPI 1972041952

  Pivotal Health Care LLC, Scenic Development LLC

  CMS ownership
• CCRC of Gladstone, LLC

  • Skilled Nursing Facility
  • Gladstone, MO
  • NPI 1033579578

  Pivotal Health Care LLC, Scenic Development LLC

  CMS ownership
• CCRC of Lees Summit, LLC

  • Skilled Nursing Facility
  • Lee'S Summit, MO
  • NPI 1205528353

  Pivotal Health Care LLC, Scenic Development LLC

  CMS ownership
• CCRC of Lenexa, LLC

  • Skilled Nursing Facility
  • Lenexa, KS
  • NPI 1144734088

  Pivotal Health Care LLC, Scenic Development LLC

  CMS ownership
• CCRC of Overland Park, LLC

  • Skilled Nursing Facility
  • Overland Park, KS
  • NPI 1063946143

  Pivotal Health Care LLC, Scenic Development LLC

  CMS ownership
• Corterra of Wichita, LLC

  • Psychiatric Hospital
  • Wichita, KS
  • NPI 1245949684

  Scenic Development LLC

  CMS ownership

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

{
    "created_epoch": "1382313600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1426636800000",
    "number": "1558799031",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11827 W 112TH ST",
            "address_2": "STE 103",
            "city": "OVERLAND PARK",
            "state": "KS",
            "postal_code": "662102726",
            "telephone_number": "913-890-4782",
            "fax_number": "913-956-6564"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2785 1ST AVE S",
            "city": "ALTOONA",
            "state": "IA",
            "postal_code": "500098820",
            "telephone_number": "515-967-8700",
            "fax_number": "515-967-6032"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CCRC OF ALTOONA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-21",
        "last_updated": "2015-03-18",
        "status": "A",
        "authorized_official_last_name": "GULLEDGE",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "913-890-4782"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0800115",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Prairie Vista Village",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Elianeth Camacho
• Jacob Anthony Campese
• Zoe Carnes
• Kimberly Caseley, HIS
• Lizbeth Cayetano, RBT
• Centers for Long Term Care of Iowa, Inc
• Central Iowa Hospital Corporation
• Samantha Cermak, BCBA
• Tena Paul Chau, DNP, FNP-C
• Christensen Chiropractic PC

• Skilled Nursing Facility in Altoona, IA
• Providers in Altoona, IA by specialty
• Skilled Nursing Facility in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.