Shady Rest, Inc.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

I-255 Issued in IA

Legal business name

SHADY REST, INC.

Doing business as

Shady Rest Care Center

Practice address

701 Johnson St NW
Cascade, IA 52033-7747

Phone

(563) 852-3277

Fax

(563) 852-7205

NPI assigned

Nov 1, 2006

Last updated

Dec 21, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Gerald J Volk

Title

President

Phone

(563) 852-3277

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Shady Rest Care Center Doing business as

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1324425600000",
    "number": "1689752297",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 JOHNSON ST NW",
            "city": "CASCADE",
            "state": "IA",
            "postal_code": "520337747",
            "telephone_number": "563-852-3277",
            "fax_number": "563-852-7205"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 JOHNSON ST NW",
            "city": "CASCADE",
            "state": "IA",
            "postal_code": "520337747",
            "telephone_number": "563-852-3277",
            "fax_number": "563-852-7205"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHADY REST, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-01",
        "last_updated": "2011-12-21",
        "status": "A",
        "authorized_official_last_name": "VOLK",
        "authorized_official_first_name": "GERALD",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "563-852-3277"
    },
    "taxonomies": [
        {
            "code": "311500000X",
            "taxonomy_group": "",
            "desc": "Alzheimer Center (Dementia Center)",
            "state": "IA",
            "license": "310255",
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "IA",
            "license": "I-255",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0803627",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shady Rest Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Skilled Nursing Facility in Cascade, IA
• Providers in Cascade, 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 Dec 21, 2011; 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.