Black Hawk Center for Independent Living

Primary specialty

BusTaxonomy code 347B00000X

License

0454736 Issued in IA

Legal business name

BLACK HAWK CENTER FOR INDEPENDENT LIVING

Doing business as

Prime Time Pass

Practice address

312 Jefferson St
Waterloo, IA 50701-1322

Phone

(319) 291-7755

Fax

(319) 291-7781

NPI assigned

Apr 22, 2007

Last updated

Aug 22, 2020By 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

Mr. David Schumaker

Title

Executive Director

Phone

(319) 291-7755

Specialties & licenses 1

Addresses

Other names 1

• Prime Time Pass Doing business as

Locations

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

{
    "created_epoch": "1177200000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1902024417",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "312 JEFFERSON ST",
            "city": "WATERLOO",
            "state": "IA",
            "postal_code": "507011322",
            "telephone_number": "319-291-7755",
            "fax_number": "319-291-7781"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "312 JEFFERSON ST",
            "city": "WATERLOO",
            "state": "IA",
            "postal_code": "507011322",
            "telephone_number": "319-291-7755",
            "fax_number": "319-291-7781"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLACK HAWK CENTER FOR INDEPENDENT LIVING",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-22",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SCHUMAKER",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "319-291-7755",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "347B00000X",
            "taxonomy_group": "",
            "desc": "Bus",
            "state": "IA",
            "license": "0454736",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Prime Time Pass",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jacqueline Michele Bilyeu, LISW
• Paula Kaye Binger, LMSW
• Birdee Cottage, LLC
• Blair J Birkett, TMLHC
• Patricia Jane Bischoff, ARNP
• Black Hawk Nursing and Rehabilitation, LLC
• Black Hawk Nursing and Rehabilitation, LLC
• Black Hawk Nursing and Rehabilitation, LLC
• Black Hawk-Grundy Mental Health Center Inc.
• Natalie Ann Bloom, ARNP, FNP-C

• Bus in Waterloo, IA
• Providers in Waterloo, IA by specialty
• Bus in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.