Organization
BLACKHAWK LIFECARE INC
Active
Other names
Blackhawk Life Care Center, Black Hawk Life Care Center
Organization subpart
No
Provider details
NPI number
Authorized official
LINDA K. JUCKETTE (PRESIDENT)
(515) 223-6064
Entity
Organization
Contact information
Practice address
73 W 5TH ST, LAKE VIEW, IA 51450-7312
(712) 657-8527
(712) 657-8618
Mailing address
73 W 5TH ST, LAKE VIEW, IA 51450-7312
(712) 657-8527
(712) 657-8618
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
N-547
IA
314000000X
Skilled Nursing Facility
810547
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0808683
—
IA
Enumeration date
02/01/2006
Last updated
01/11/2022
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