1740282391 NPI number — ABCM CORPORATION

Table of content: MISS CARISA MARIE HOUSTON SAC (NPI 1376729996)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740282391 NPI number — ABCM CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ABCM CORPORATION
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:
WESTVIEW OF INDIANOLA CARE 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:
1740282391
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/25/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1320 4TH ST NE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAMPTON
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50441-1104
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
641-456-5636
Provider Business Mailing Address Fax Number:
641-456-2320

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1900 W 3RD PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INDIANOLA
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50125-2104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-961-3189
Provider Business Practice Location Address Fax Number:
515-962-1288
Provider Enumeration Date:
08/12/2005

Additional Information

Authorized Official

Authorized Official Last Name:
ALLBEE
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
ALBERT
Authorized Official Title or Position:
CHAIRMAN & CEO
Authorized Official Telephone Number:
641-456-5636

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QA0600X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 314000000X , with the licence number: 910176 , 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: NF WAIVER-NOT ASSIGN , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0804799 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 65369 . This is a "WELLMARK" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".




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