Basic Information
| Provider Information | |||||||||
| NPI: | 1407162563 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HAWKEYE CARE CENTER OF CARROLL | ||||||||
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| OtherOrganizationName: | HAWKEYE CARE CENTER CARROLL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1912 ZENITH AVE | ||||||||
| Address2: | SUITE 2526 | ||||||||
| City: | SPIRIT LAKE | ||||||||
| State: | IA | ||||||||
| PostalCode: | 513601000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7127591321 | ||||||||
| FaxNumber: | 7127591322 | ||||||||
| Practice Location | |||||||||
| Address1: | 2241 N WEST ST | ||||||||
| Address2: | |||||||||
| City: | CARROLL | ||||||||
| State: | IA | ||||||||
| PostalCode: | 514013607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7127929284 | ||||||||
| FaxNumber: | 7127924883 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/27/2010 | ||||||||
| LastUpdateDate: | 09/08/2015 | ||||||||
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| AuthorizedOfficialLastName: | HAMM | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | T | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 5152230173 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 140024 | IA | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.