Provider Demographics
NPI:1407817653
Name:HALLMARK CARE LLC
Entity Type:Organization
Organization Name:HALLMARK CARE LLC
Other - Org Name:HALLMARK CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:ZIMBELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-232-9573
Mailing Address - Street 1:3800 INDIAN HILLS DR
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51104-1620
Mailing Address - Country:US
Mailing Address - Phone:712-239-5025
Mailing Address - Fax:712-239-5040
Practice Address - Street 1:3800 INDIAN HILLS DR
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51104-1620
Practice Address - Country:US
Practice Address - Phone:712-239-5025
Practice Address - Fax:712-239-5040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-29
Last Update Date:2013-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA970179314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0805150Medicaid
165435Medicare Oscar/Certification