Provider Demographics
NPI:1467415760
Name:HAWKEYE CARE CENTER OF DUBUQUE, LLC
Entity Type:Organization
Organization Name:HAWKEYE CARE CENTER OF DUBUQUE, LLC
Other - Org Name:HAWKEYE CARE CENTER DUBUQUE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
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 1:2900 100TH ST STE 203
Mailing Address - Street 2:
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50322-3851
Mailing Address - Country:US
Mailing Address - Phone:152-230-1735
Mailing Address - Fax:
Practice Address - Street 1:5575 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:ASBURY
Practice Address - State:IA
Practice Address - Zip Code:52002-2595
Practice Address - Country:US
Practice Address - Phone:563-583-6447
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-08
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA310463314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0809806Medicaid
IA165565Medicare Oscar/Certification