Hiawatha Manor, Inc.

Primary specialty

Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X

License

801035-1-RS Issued in MN

Legal business name

HIAWATHA MANOR, INC.

Practice address

107 5TH Ave NE
Pipestone, MN 56164-1928

Phone

(507) 825-5697

NPI assigned

Apr 15, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Christine Robinson

Title

Administrator

Phone

(507) 825-5697

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1208217600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208217600000",
    "number": "1508030156",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "107 5TH AVE NE",
            "address_2": "PO BOX 247",
            "city": "PIPESTONE",
            "state": "MN",
            "postal_code": "561641928",
            "telephone_number": "507-825-5697"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 5TH AVE NE",
            "city": "PIPESTONE",
            "state": "MN",
            "postal_code": "561641928",
            "telephone_number": "507-825-5697"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HIAWATHA MANOR, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-15",
        "last_updated": "2008-04-15",
        "status": "A",
        "authorized_official_last_name": "ROBINSON",
        "authorized_official_first_name": "CHRISTINE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "507-825-5697"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "MN",
            "license": "801035-1-RS",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nicole Lamore Grandsberry
• Morgan Guardado
• Sarah Hacker, BS
• Danica Marie Hegstad
• Paul A. Henriksen, O.D.
• Cassandra Ann Hoefs, RN, BSN, PHN
• Hubers, Inc.
• Inspire Counseling Services LTD
• Adrianna Johnson
• Jarolyn Johnson, LMFT

• All providers in Pipestone, MN
• Intellectual Disabilities Intermediate Care Facility in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.