Provider Demographics
NPI:1851988414
Name:HAWK HOUSE LLC
Entity Type:Organization
Organization Name:HAWK HOUSE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MATAELE
Authorized Official - Middle Name:
Authorized Official - Last Name:KAVEINGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-202-3461
Mailing Address - Street 1:15227 W COUNTRY GABLES DR
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85379-7025
Mailing Address - Country:US
Mailing Address - Phone:715-202-3461
Mailing Address - Fax:602-806-6203
Practice Address - Street 1:15227 W COUNTRY GABLES DR
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85379-7025
Practice Address - Country:US
Practice Address - Phone:715-202-3461
Practice Address - Fax:602-806-6203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-29
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness