Provider Demographics
NPI:1720447063
Name:HOPE HAVEN AREA DEVELOPMENT CENTER CORPORATION
Entity Type:Organization
Organization Name:HOPE HAVEN AREA DEVELOPMENT CENTER CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:BARTLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-237-1333
Mailing Address - Street 1:828 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52601-4921
Mailing Address - Country:US
Mailing Address - Phone:319-754-4689
Mailing Address - Fax:
Practice Address - Street 1:828 N 7TH ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52601-4921
Practice Address - Country:US
Practice Address - Phone:319-754-4689
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-15
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1275735342Medicaid
IA1881890788Medicaid
IA1902008089Medicaid
IA1093917171Medicaid
IA1215061197Medicaid
IA1144354614Medicaid
IA1801920525Medicaid