Provider Demographics
NPI:1689896292
Name:HAWTHORNE INN AT WINDMILL POINTE
Entity type:Organization
Organization Name:HAWTHORNE INN AT WINDMILL POINTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:E
Authorized Official - Last Name:FRINK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-337-6320
Mailing Address - Street 1:1500 1ST AVENUE NORTH
Mailing Address - Street 2:
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241
Mailing Address - Country:US
Mailing Address - Phone:319-337-6320
Mailing Address - Fax:319-337-3099
Practice Address - Street 1:1500 1ST AVENUE NORTH
Practice Address - Street 2:
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241
Practice Address - Country:US
Practice Address - Phone:319-337-6320
Practice Address - Fax:319-337-3099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAS0111310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0493700Medicaid