# BLACKHAWK LIFECARE INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Blackhawk Life Care Center, Black Hawk Life Care Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1649242074
- **Authorized official:** LINDA K. JUCKETTE (PRESIDENT)
- **Authorized official phone:** (515) 223-6064

## Contact information

- **Practice address:** 73 W 5TH ST, LAKE VIEW, IA 51450-7312
- **Practice address phone:** (712) 657-8527
- **Practice address fax:** (712) 657-8618
- **Mailing address:** 73 W 5TH ST, LAKE VIEW, IA 51450-7312
- **Mailing address phone:** (712) 657-8527
- **Mailing address fax:** (712) 657-8618

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 313M00000X | Nursing Facility/Intermediate Care Facility | N-547 | IA | Yes |
| 314000000X | Skilled Nursing Facility | 810547 | IA | — |

## Other

- **Enumeration date:** 02/01/2006
- **Last updated:** 01/11/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0808683 | — | IA |