Active NPI
JP Senior Healthcare LLC
Doing business as Pioneer Valley Living and Rehab Center
- Skilled Nursing Facility
- Sergeant Bluff, IA
National Provider Identifier
1841666054
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- Legal business name
- JP SENIOR HEALTHCARE LLC
- Doing business as
- Pioneer Valley Living and Rehab Center
- Practice address
- 400 Sergeant Square Drive
Sergeant Bluff, IA 51054 - Phone
- (712) 574-7312
- NPI assigned
- Aug 12, 2015
- Last updated
- Sep 21, 2016
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Joseph P Dewitt
- Title
- Cfo
- Phone
- (712) 574-7312
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | NU | Primary |
Addresses
Primary practice location
400 Sergeant Square Drive
Sergeant Bluff, IA 51054
Mailing address
PO Box 2246
Sioux City, IA 51104-0246
Phone (712) 574-7312
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0800187 | Medicaid | IA |
Other names 1
- Pioneer Valley Living and Rehab Center
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20160106000956 | IA | Part A Provider - Skilled Nursing Facility | 9032390364 | Practice locations: Sergeant Bluff, IA |
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1841666054. Details of each certification follow.
Skilled nursing facility certification: CCN 165615
- Legal name
- JP SENIOR HEALTHCARE LLC
- Doing business as
- PIONEER VALLEY LIVING AND REHAB
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Jun 21, 2016
- Last certification
- Feb 6, 2025
- Beds
- 66
- Ownership / control type
- Limited Liability Corporation
- Organization structure
- LLC
- Enrollment address
- 400 Sergeant Square Dr
Sergeant Bluff, IA 51054-8599 - Nursing home name
- PIONEER VALLEY LIVING AND REHAB
Care Compare: Nursing home
Medicare Care Compare- Listed as
- Pioneer Valley Living And Rehab
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- For profit - Limited Liability company
- Certified
- Jun 21, 2016
- Medicare certification status
- Active
- Certified beds
- 66
- Penalties (3 years)
- 1
National Provider Directory
National Provider Directory- Tax ID family
- Buena Vista Manor Care Center Inc
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Skilled Nursing Facility
- Storm Lake, IA
- NPI 1912993841
Locations
400 Sergeant Square Dr
Sergeant Bluff, IA 51054
Phone (712) 574-7312
Ownership & related parties
All disclosed owners & managing parties 6
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Joseph P Dewitt | Limited Partnership Interest | Mar 1, 2011 | 4.9% |
| Operational/Managerial Control | Jan 1, 2022 | ||
| Adp of the SNF | Jan 1, 2016 | ||
| Direct Ownership Interest | Jan 1, 2018 | 4.9% | |
| Patrick L Henggeler | Limited Partnership Interest | Sep 25, 2009 | 90.2% |
| Operational/Managerial Control | Jan 1, 2016 | ||
| Direct Ownership Interest | Jan 1, 2018 | 90.2% | |
| Tim Nielsen | Operational/Managerial Control | Apr 5, 2021 | |
| Jason T Losee | Adp of the SNF | Jan 1, 2024 | |
| JP Senior Management LLC | Operational/Managerial Control | Mar 1, 2016 | |
| Adp of the SNF | May 27, 2025 | ||
| Stephanie D Amick | Limited Partnership Interest | Jan 1, 2018 | 4.9% |
| Operational/Managerial Control | May 22, 2024 | ||
| Adp of the SNF | Jun 1, 2016 | ||
| Direct Ownership Interest | Jan 1, 2018 | 4.9% |
Owners & managing parties with NPI records 1
Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.
Practitioners & affiliated clinicians
Affiliated clinicians 8
Clinicians who list this facility as an affiliation in Medicare Care Compare.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1439337600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1474416000000",
"number": "1841666054",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2246",
"city": "SIOUX CITY",
"state": "IA",
"postal_code": "511040246",
"telephone_number": "712-574-7312",
"fax_number": "712-277-8313"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "400 SERGEANT SQUARE DRIVE",
"city": "SERGEANT BLUFF",
"state": "IA",
"postal_code": "51054",
"telephone_number": "712-574-7312"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "JP SENIOR HEALTHCARE LLC",
"organizational_subpart": "NO",
"enumeration_date": "2015-08-12",
"last_updated": "2016-09-21",
"status": "A",
"authorized_official_last_name": "DEWITT",
"authorized_official_first_name": "JOSEPH",
"authorized_official_middle_name": "P",
"authorized_official_title_or_position": "CFO",
"authorized_official_telephone_number": "712-574-7312",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0800187",
"state": "IA"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Pioneer Valley Living and Rehab Center",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Sergeant Bluff, IA
- Hawkeye Clinic of Sergeant Bluff, PC
- John Addison Hildman
- Renee L. Husen, D.D.S.
- Stacey A Jackson, PHARMD
- Jiwa Chiropractic & Wellness
- Kismet Sux LLC (WEL-Home Health Sergeant Bluff)
- Kismet Sux LLC (Embassy Rehab and Care Center)
- Bonnie Sue Knutson, PTA
- Katelyn Jean Kudrna, O.D.
- Kyle F Richards PC (Richards Counseling & Consulting)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2016; 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.