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General NPI Number Information
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NPI Number | 1285630541
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Entity Type | Organization
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Legal Business Name | HIAWATHA CARE CENTER INC
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Dates
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Enumeration Date | 06/22/2005
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Last Update Date | 01/27/2012
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Provider Practice Location Address
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Address Line | 405 N 15TH AVE
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City | HIAWATHA
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State | IA
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Zip | 52233-2347
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Country | US
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Telephone | 319-378-8583
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Fax | 319-378-8598
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Provider Business Mailing Address
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Address Line | 405 N 15TH AVE
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City | HIAWATHA
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State | IA
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Zip | 52233-2347
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Country | US
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Telephone | 319-378-8583
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Fax | 319-378-8598
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Authorized Official
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Title or Position | CORPORATE SECRETARY
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Name | KENNETH D. CARLSON
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Credential |
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Telephone | 515-223-6064
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 570660
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | 570660
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License Number State | IA
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