Provider Demographics
NPI:1184706566
Name:HOPE HAVEN INC
Entity type:Organization
Organization Name:HOPE HAVEN INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DUANE
Authorized Official - Middle Name:R
Authorized Official - Last Name:OBBINK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-476-2737
Mailing Address - Street 1:1800 19TH STREET
Mailing Address - Street 2:
Mailing Address - City:ROCK VALLEY
Mailing Address - State:IA
Mailing Address - Zip Code:51247
Mailing Address - Country:US
Mailing Address - Phone:712-476-2737
Mailing Address - Fax:712-476-3110
Practice Address - Street 1:1800 19TH STREET
Practice Address - Street 2:
Practice Address - City:ROCK VALLEY
Practice Address - State:IA
Practice Address - Zip Code:51247
Practice Address - Country:US
Practice Address - Phone:712-476-2737
Practice Address - Fax:712-476-3110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0893065313M00000X
IA0893073313M00000X
IA0892745313M00000X
IA0880666313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
0893065OtherRCF MR
IA1103788OtherREMEDIAL
IA1560862Medicaid
0231621OtherARO
0893073OtherRCF MR
0248252OtherARO
0880666OtherICF MR
0096628OtherHCBS RB SCL
0892745OtherRCF MR
IA4950121Medicaid
0892745OtherRCF MR