Provider Demographics
NPI:1508839325
Name:M & D HAMM INC
Entity Type:Organization
Organization Name:M & D HAMM INC
Other - Org Name:HAWKEYE CARE CENTER SIOUX RAPIDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:D
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 1:702 BLAKE ST
Practice Address - Street 2:
Practice Address - City:SIOUX RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:50585-1121
Practice Address - Country:US
Practice Address - Phone:712-283-2302
Practice Address - Fax:712-283-2487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-10
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA110599314000000X, 332U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No332U00000XSuppliersHome Delivered Meals
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0803692Medicaid
IA165403Medicare Oscar/Certification