Provider Demographics
NPI:1174858872
Name:M & D HAMM, INC.
Entity Type:Organization
Organization Name:M & D HAMM, INC.
Other - Org Name:HAWKEYE ASSISTED LIVING BANCROFT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DOUG
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-223-0173
Mailing Address - Street 1:1912 ZENITH AVE
Mailing Address - Street 2:SUITE 2526
Mailing Address - City:SPIRIT LAKE
Mailing Address - State:IA
Mailing Address - Zip Code:51360-1000
Mailing Address - Country:US
Mailing Address - Phone:712-759-1321
Mailing Address - Fax:712-759-1322
Practice Address - Street 1:548 EAST RAMSEY
Practice Address - Street 2:
Practice Address - City:BANCROFT
Practice Address - State:IA
Practice Address - Zip Code:50517
Practice Address - Country:US
Practice Address - Phone:515-885-2463
Practice Address - Fax:515-885-2759
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:M & D HAMM, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-10-14
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAS0294310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility