1851457667 NPI number — IOWA ODD FELLOWS & ORPHANS HOME

Table of content: (NPI 1851457667)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851457667 NPI number — IOWA ODD FELLOWS & ORPHANS HOME

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
IOWA ODD FELLOWS & ORPHANS HOME
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:
IOOF HOME AND COMMUNITY THERAPY CENTER
Provider Other Organization Name Type Code:
3
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:
1851457667
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/03/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1037 19TH ST SW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MASON CITY
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50401-6436
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
641-423-0428
Provider Business Mailing Address Fax Number:
641-424-1068

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1037 19TH ST SW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MASON CITY
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50401-6436
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
641-423-0428
Provider Business Practice Location Address Fax Number:
641-424-1068
Provider Enumeration Date:
12/28/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HELGESON
Authorized Official First Name:
SCOTT
Authorized Official Middle Name:
N
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
641-423-0428

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  170134 , 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: 0802041 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".