Healthcare Provider Details

I. General information

NPI: 1407162563
Provider Name (Legal Business Name): HAWKEYE CARE CENTER OF CARROLL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2010
Last Update Date: 09/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2241 N WEST ST
CARROLL IA
51401-3607
US

IV. Provider business mailing address

1912 ZENITH AVE SUITE 2526
SPIRIT LAKE IA
51360-1000
US

V. Phone/Fax

Practice location:
  • Phone: 712-792-9284
  • Fax: 712-792-4883
Mailing address:
  • Phone: 712-759-1321
  • Fax: 712-759-1322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number140024
License Number StateIA

VIII. Authorized Official

Name: MR. MICHAEL T HAMM
Title or Position: CEO
Credential:
Phone: 515-223-0173