Healthcare Provider Details

I. General information

NPI: 1801849740
Provider Name (Legal Business Name): HAWKEYE HEALTH SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 01/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1109 HIGHWAY 18 EAST
ALGONA IA
50511-1107
US

IV. Provider business mailing address

4232 UNIVERSITY AVE
DES MOINES IA
50311-3422
US

V. Phone/Fax

Practice location:
  • Phone: 515-295-5551
  • Fax: 515-295-6892
Mailing address:
  • Phone: 515-277-0977
  • Fax: 515-277-1587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier16D0897765
Identifier TypeOTHER
Identifier StateIA
Identifier IssuerCLIA
# 2
Identifier0673038
Identifier TypeMEDICAID
Identifier StateIA
Identifier Issuer

VIII. Authorized Official

Name: MR. LEW LITTLE JR.
Title or Position: CEO
Credential:
Phone: 512-634-4900