Healthcare Provider Details

I. General information

NPI: 1427385582
Provider Name (Legal Business Name): HAWKEYE CARE CENTERS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2009
Last Update Date: 09/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 H AVENUE
MILFORD IA
51351
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 712-338-4742
  • Fax: 712-338-2281
Mailing address:
  • Phone: 712-759-1321
  • Fax: 712-759-1321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberS0298
License Number StateIA

VIII. Authorized Official

Name: DOUG JOHNSON
Title or Position: PRESIDENT
Credential:
Phone: 515-223-0173