=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750088654
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HIAWATHA HOMES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/10/2023
-----------------------------------------------------
Last Update Date | 02/10/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1820 VALKYRIE DR NW
-----------------------------------------------------
City | ROCHESTER
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55901-2441
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 507-289-7222
-----------------------------------------------------
Fax | 507-289-8007
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1820 VALKYRIE DR NW
-----------------------------------------------------
City | ROCHESTER
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55901-2441
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 507-289-7222
-----------------------------------------------------
Fax | 507-289-8007
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | CYNTHIA OSTROWSKI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 507-226-0710
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 320900000X
-----------------------------------------------------
Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------