Provider Demographics
NPI:1003086604
Name:PROMISE HOUSE HIAWATHA INC.
Entity Type:Organization
Organization Name:PROMISE HOUSE HIAWATHA INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KENT
Authorized Official - Middle Name:
Authorized Official - Last Name:WALTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-378-8583
Mailing Address - Street 1:405 N 15TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIAWATHA
Mailing Address - State:IA
Mailing Address - Zip Code:52233-2347
Mailing Address - Country:US
Mailing Address - Phone:319-378-8583
Mailing Address - Fax:
Practice Address - Street 1:1320 LITCHFIELD DR
Practice Address - Street 2:
Practice Address - City:HIAWATHA
Practice Address - State:IA
Practice Address - Zip Code:52233-2343
Practice Address - Country:US
Practice Address - Phone:319-743-9812
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-11
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility