1588992994 NPI number — DHS-TARGETED CASE MANAGEMENT

Table of content: (NPI 1588992994)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588992994 NPI number — DHS-TARGETED CASE MANAGEMENT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DHS-TARGETED CASE MANAGEMENT
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:
1588992994
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/23/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 SW 8TH ST
Provider Second Line Business Mailing Address:
SUITE Q
Provider Business Mailing Address City Name:
DES MOINES
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50309-4619
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
515-281-7775
Provider Business Mailing Address Fax Number:
515-281-3234

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 SW 8TH ST
Provider Second Line Business Practice Location Address:
SUITE Q
Provider Business Practice Location Address City Name:
DES MOINES
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50309-4619
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-281-7775
Provider Business Practice Location Address Fax Number:
515-281-3234
Provider Enumeration Date:
11/23/2009

Additional Information

Authorized Official

Authorized Official Last Name:
DIAMOND
Authorized Official First Name:
DIANE
Authorized Official Middle Name:
Authorized Official Title or Position:
BUREAU CHIEF
Authorized Official Telephone Number:
515-281-7156

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X , 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: 1054007 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2054007 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4054007 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5054007 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3054007 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 743096 . This is a "MAGELLAN BEHAVIORAL CARE OF IOWA" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 6054007 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8054007 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




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