Provider Demographics
NPI:1881890788
Name:HOPE HAVEN COTTONWOOD
Entity type:Organization
Organization Name:HOPE HAVEN COTTONWOOD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PROGRAMS
Authorized Official - Prefix:
Authorized Official - First Name:RON
Authorized Official - Middle Name:
Authorized Official - Last Name:CHRISTENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-237-1308
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:319-753-6701
Mailing Address - Fax:319-754-0045
Practice Address - Street 1:910 COTTONWOOD CT STE 1002
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52601-1994
Practice Address - Country:US
Practice Address - Phone:319-753-6701
Practice Address - Fax:319-754-0045
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOPE HAVEN AREA DEVELOPMENT CENTER CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-06-26
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA290970320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities