Provider Demographics
NPI:1407162563
Name:HAWKEYE CARE CENTER OF CARROLL
Entity Type:Organization
Organization Name:HAWKEYE CARE CENTER OF CARROLL
Other - Org Name:HAWKEYE CARE CENTER CARROLL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:T
Authorized Official - Last Name:HAMM
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 1:2241 N WEST ST
Practice Address - Street 2:
Practice Address - City:CARROLL
Practice Address - State:IA
Practice Address - Zip Code:51401-3607
Practice Address - Country:US
Practice Address - Phone:712-792-9284
Practice Address - Fax:712-792-4883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-27
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA140024314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA165455Medicare Oscar/Certification