Healthcare Provider Details

I. General information

NPI: 1285630541
Provider Name (Legal Business Name): HIAWATHA CARE CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 01/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 N 15TH AVE
HIAWATHA IA
52233-2347
US

IV. Provider business mailing address

405 N 15TH AVE
HIAWATHA IA
52233-2347
US

V. Phone/Fax

Practice location:
  • Phone: 319-378-8583
  • Fax: 319-378-8598
Mailing address:
  • Phone: 319-378-8583
  • Fax: 319-378-8598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number570660
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number570660
License Number StateIA

VIII. Authorized Official

Name: KENNETH D. CARLSON
Title or Position: CORPORATE SECRETARY
Credential:
Phone: 515-223-6064