Healthcare Provider Details

I. General information

NPI: 1881663276
Provider Name (Legal Business Name): HEGG MEMORIAL HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 06/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2116 14TH ST
ROCK VALLEY IA
51247-1422
US

IV. Provider business mailing address

2116 14TH ST
ROCK VALLEY IA
51247-1422
US

V. Phone/Fax

Practice location:
  • Phone: 712-476-8200
  • Fax: 712-476-8290
Mailing address:
  • Phone: 712-476-8200
  • Fax: 712-476-8290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number840049H
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number0448654
License Number StateIA

VIII. Authorized Official

Name: MR. GLENN ZEVENBERGEN
Title or Position: ADMINISTRATOR
Credential:
Phone: 712-476-8000