1336125921 NPI number — CENTRAL IOWA HEALTHCARE

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336125921 NPI number — CENTRAL IOWA HEALTHCARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRAL IOWA HEALTHCARE
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:
CIH HOME CARE
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:
1336125921
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/05/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3 S 4TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARSHALLTOWN
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50158-2998
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
641-754-5145
Provider Business Mailing Address Fax Number:
641-844-6208

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3 S 4TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARSHALLTOWN
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50158-2998
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
641-754-6353
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/16/2005

Additional Information

Authorized Official

Authorized Official Last Name:
WILLIS
Authorized Official First Name:
DAWNETT
Authorized Official Middle Name:
L
Authorized Official Title or Position:
ACTING CEO
Authorized Official Telephone Number:
641-754-5145

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0671164 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 67116 . This is a "BLUE CROSS" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".




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