Provider Demographics
NPI:1255407268
Name:HUMBOLDT COUNTY MEMORIAL HOSPITAL
Entity type:Organization
Organization Name:HUMBOLDT COUNTY MEMORIAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:FEASTER
Authorized Official - Suffix:
Authorized Official - Credentials:LBSW
Authorized Official - Phone:515-332-2492
Mailing Address - Street 1:1012 15TH ST N
Mailing Address - Street 2:
Mailing Address - City:HUMBOLDT
Mailing Address - State:IA
Mailing Address - Zip Code:50548-1008
Mailing Address - Country:US
Mailing Address - Phone:515-332-2492
Mailing Address - Fax:515-332-4756
Practice Address - Street 1:1012 15TH ST N
Practice Address - Street 2:
Practice Address - City:HUMBOLDT
Practice Address - State:IA
Practice Address - Zip Code:50548-1008
Practice Address - Country:US
Practice Address - Phone:515-332-2492
Practice Address - Fax:515-332-4756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0615641Medicaid
IA61536OtherBCBS HOSPICE
IA161536Medicare Oscar/Certification