Provider Demographics
NPI:1174068969
Name:HANSEN HOUSE MEMORY CARE RESIDENCE
Entity type:Organization
Organization Name:HANSEN HOUSE MEMORY CARE RESIDENCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCARTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-709-2062
Mailing Address - Street 1:2331 NASH BLVD
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51501-0914
Mailing Address - Country:US
Mailing Address - Phone:712-256-4525
Mailing Address - Fax:712-256-4526
Practice Address - Street 1:2331 NASH BLVD
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51501-0914
Practice Address - Country:US
Practice Address - Phone:712-256-4525
Practice Address - Fax:712-256-4526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-03
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAS0330311500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)