1316029705 NPI number — WEST CENTRAL MENTAL HEALTH CENTER, INC.

Table of content: (NPI 1316029705)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316029705 NPI number — WEST CENTRAL MENTAL HEALTH CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WEST CENTRAL MENTAL HEALTH CENTER, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316029705
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ADEL
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50003-0007
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
515-993-4535
Provider Business Mailing Address Fax Number:
515-993-3845

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2111 W GREEN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ADEL
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50003-1637
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-993-4535
Provider Business Practice Location Address Fax Number:
515-993-3845
Provider Enumeration Date:
10/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KUCKELMAN
Authorized Official First Name:
ASHLEY
Authorized Official Middle Name:
R.
Authorized Official Title or Position:
CAO
Authorized Official Telephone Number:
515-993-4535

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0074476 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0742825 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




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