1114061272 NPI number — RURAL EMPLOYMENT ALTERNATIVES, INC

Table of content: (NPI 1114061272)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114061272 NPI number — RURAL EMPLOYMENT ALTERNATIVES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RURAL EMPLOYMENT ALTERNATIVES, 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:
1114061272
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
495 4TH AVENUE - P. O. BOX 24
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CONROY
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52220
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
319-662-4043
Provider Business Mailing Address Fax Number:
319-662-4403

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
495 4TH AVE.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CONROY
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-662-4043
Provider Business Practice Location Address Fax Number:
319-662-4403
Provider Enumeration Date:
02/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SCANDRIDGE
Authorized Official First Name:
JEANNINE
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
319-662-4043

Provider Taxonomy Codes

  • Taxonomy code: 251C00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com