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General NPI Number Information
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NPI Number | 1578535548
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Entity Type | Organization
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Legal Business Name | HAWKEYE CARE CENTER OF SPIRIT LAKE, LLC
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Dates
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Enumeration Date | 02/03/2006
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Last Update Date | 09/01/2015
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Provider Practice Location Address
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Address Line | 1912 ZENITH AVE
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City | SPIRIT LAKE
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State | IA
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Zip | 51360
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Country | US
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Telephone | 712-336-3300
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Fax |
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Provider Business Mailing Address
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Address Line | 1912 ZENITH AVE SUITE 2526
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City | SPIRIT LAKE
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State | IA
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Zip | 51360-1000
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Country | US
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Telephone | 712-759-1321
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Fax | 712-759-1322
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Authorized Official
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Title or Position | PRESIDENT
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Name | DOUG JOHNSON
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Credential |
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Telephone | 515-223-0173
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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 | 300353
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License Number State | IA
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