Provider Demographics
NPI:1841373735
Name:HUMBOLDT WORKSHOP, INC
Entity type:Organization
Organization Name:HUMBOLDT WORKSHOP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:KELLNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-332-2841
Mailing Address - Street 1:21 TAFT ST N
Mailing Address - Street 2:PO BOX 587
Mailing Address - City:HUMBOLDT
Mailing Address - State:IA
Mailing Address - Zip Code:50548-1768
Mailing Address - Country:US
Mailing Address - Phone:515-332-2841
Mailing Address - Fax:515-332-1915
Practice Address - Street 1:21 TAFT ST N
Practice Address - Street 2:
Practice Address - City:HUMBOLDT
Practice Address - State:IA
Practice Address - Zip Code:50548-1768
Practice Address - Country:US
Practice Address - Phone:515-332-2841
Practice Address - Fax:515-332-1915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA311Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0892885Medicaid